San Diego Mental Health Associates Medical Clinic Inc.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

C25697 Issued in CA

Legal business name

SAN DIEGO MENTAL HEALTH ASSOCIATES MEDICAL CLINIC INC.

Practice address

3914 Third Avenue
San Diego, CA 92103-3094

Phone

(619) 291-4808

Fax

(619) 291-4426

NPI assigned

Jun 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Glenise C Trapp

Title

Office Manager

Phone

(619) 291-4808

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1043415847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3914 THIRD AVENUE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033094",
            "telephone_number": "619-291-4808",
            "fax_number": "619-291-4426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3914 THIRD AVENUE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033094",
            "telephone_number": "619-291-4808",
            "fax_number": "619-291-4426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO MENTAL HEALTH ASSOCIATES MEDICAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "TRAPP",
        "authorized_official_first_name": "GLENISE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "619-291-4808",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C25697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ72044Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.