MEDICARE: URI KUGEL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY28642	CA

General Provider Information

NPI Number	:	1164893442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	URI KUGEL PH.D.

Provider Business Mailing Address
First Line	:	7462 BRENTWOOD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-4330
Country	:	US
Telephone Number	:	510-213-8740
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 CARROLL CANYON RD
Second Line	:	STE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1779
Country	:	US
Telephone Number	:	510-213-8740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	08/08/2019

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