Individual provider Active NPI

Philip Watson

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1619477767
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35748 Issued in CA
Practice address
12636 High Bluff Dr Ste 400
San Diego, CA 92130-2071
Phone
(619) 830-9552
NPI assigned
Feb 15, 2018
Last updated
Aug 10, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 35748 CA Primary

Addresses

Primary practice location

12636 High Bluff Dr Ste 400
San Diego, CA 92130-2071

Mailing address

5505 Stevens Way Unit 740244
San Diego, CA 92174-7011
Phone (619) 830-9552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250915000685 CA Practitioner - Clinical Psychologist 5395248330 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Halliday Center for Psychotherapy and Wellness, IncGroup PAC ID 3375767437, 10 clinicians

Practice addresses (Care Compare)

12625 High Bluff Dr
Suite 216
San Diego, CA 92130-2054
Phone (760) 635-3310

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Halliday Center for Psychotherapy and Wellness, Inc. Clinical CurrentSince Aug 4, 2025 Accepting new patients
Iterra Psychological Services Apc Psychologist Current Accepting new patients
ASC Treatment Group Past Accepting new patients

Locations

355 Santa Fe Dr
Ste 200
Encinitas, CA 92024
Phone (760) 473-3235

12625 High Bluff Dr
Ste 216
San Diego, CA 92130
Phone (619) 952-5321

12636 High Bluff Dr
Ste 400
San Diego, CA 92130
Phone (619) 992-4519

5505 Stevens Way
Unit 740244
San Diego, CA 92174

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786320000000",
    "number": "1619477767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 STEVENS WAY UNIT 740244",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921747011",
            "telephone_number": "619-830-9552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12636 HIGH BLUFF DR STE 400",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921302071",
            "telephone_number": "619-830-9552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "PHILIP",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-15",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "35748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.