MEDICARE: DR. MARY HARB SHEETS 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	103T00000X	Psychologist	PSY13803	CA

General Provider Information

NPI Number	:	1255427845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY HARB SHEETS PH.D.

Provider Business Mailing Address
First Line	:	12803 PIMPERNEL WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-3603
Country	:	US
Telephone Number	:	858-484-8332
Fax Number	:

Provider Business Practice Location Address
First Line	:	9330 CARMEL MOUNTAIN RD
Second Line	:	SUITE A
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2157
Country	:	US
Telephone Number	:	858-484-8332
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	04/15/2013

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