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NPI Code Detail

MEDICARE: DR. MICHAEL DAVID IRVIN PSY.D.

MEDICARE: DR. MICHAEL DAVID IRVIN PSY.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 PsychologistPSB34895CA

General Provider Information

NPI Number : 1851614291
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL DAVID IRVIN PSY.D.
Provider Business Mailing Address
First Line : 14750 EL CAMINO REAL
Second Line : CASA PALMERA TREATMENT CENTER
City : DEL MAR
State : CA
Zip : 92014-4204
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14750 EL CAMINO REAL
Second Line : CASA PALMERA TREATMENT CENTER
City : DEL MAR
State : CA
Zip : 92014-4204
Country : US
Telephone Number : 760-733-6962
Fax Number : 760-733-6962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2010
Last Update Date : 10/24/2012

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