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NPI Code Detail

MEDICARE: ITERRA PSYCHOLOGICAL SERVICES APC

MEDICARE: ITERRA PSYCHOLOGICAL SERVICES APC
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
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1508719758
Entity Type Code : Organization
Provider Name (Legal Business Name) : ITERRA PSYCHOLOGICAL SERVICES APC
Provider Business Mailing Address
First Line : PO BOX 740244
Second Line :
City : SAN DIEGO
State : CA
Zip : 92174-0244
Country : US
Telephone Number : 619-830-9552
Fax Number :
Provider Business Practice Location Address
First Line : 12636 HIGH BLUFF DR STE 400
Second Line :
City : SAN DIEGO
State : CA
Zip : 92130-2071
Country : US
Telephone Number : 619-830-9552
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : PHILIP WATSON
Credential : PSYD
Telephone Number : 619-830-9552
Provider Enumeration Date : 02/17/2026
Last Update Date : 04/13/2026

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