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NPI Code Detail

MEDICARE: DR. JAMES JOSEPH BAZZETTA PH.D.

MEDICARE: DR. JAMES JOSEPH BAZZETTA 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
1103TC0700XClinical PsychologistPSY 24443CA

General Provider Information

NPI Number : 1619162609
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES JOSEPH BAZZETTA PH.D.
Provider Business Mailing Address
First Line : 12636 HIGH BLUFF DR STE 400
Second Line :
City : SAN DIEGO
State : CA
Zip : 92130-2071
Country : US
Telephone Number : 619-993-8318
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 : 619-993-8318
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2007
Last Update Date : 06/21/2019

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