MEDICARE: DR. GERALD ALLEN VERNON 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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PSY5995	CA
2	103TC0700X	Clinical Psychologist	PSY5995	CA

General Provider Information

NPI Number	:	1235100959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD ALLEN VERNON PH.D.

Provider Business Mailing Address
First Line	:	14185 MANGO DR
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2924
Country	:	US
Telephone Number	:	619-553-0426
Fax Number	:	619-553-8945

Provider Business Practice Location Address
First Line	:	50 ROSECRANS ST
Second Line	:	BLDG 500
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-4408
Country	:	US
Telephone Number	:	619-553-0426
Fax Number	:	619-553-8945

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	09/11/2025

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