Charles Vincent Ettari, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G16786 Issued in CA

Practice address

9888 Genesee Ave
La Jolla, CA 92037-1205

Phone

(619) 277-9887

Fax

(801) 253-9831

NPI assigned

Jul 17, 2006

Last updated

Nov 23, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: cettari43000@scrippshlth.medalliesdirect.net

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.

• Scripps Health

  dba Scripps Hospital Medical Services

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1487928891
  NPD

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574467200000",
    "number": "1629096631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2216",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920141516",
            "telephone_number": "619-277-9887",
            "fax_number": "801-253-9831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "619-277-9887",
            "fax_number": "801-253-9831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTARI",
        "first_name": "CHARLES",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2019-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G16786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOG 167860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sado Hussein Essa
• Essential Healthcare Group
• Essenza Mind & Body Longevity Clinic
• Clarissa Estrella
• Marjan Etesami, M.D.
• Desiree M Evans-Claassen, P.A.
• Briana Cara Evans, L.C.S.W.
• Elisabeth Evans, N.P.
• J Rotsen Evaristo, M.D.
• Amy Evenstad, PHARMD

• Psychiatry Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2019; 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.