Charles V. Ettari, M.D., Inc.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G16786 Issued in CA

Legal business name

CHARLES V. ETTARI, M.D., INC.

Practice address

9834 Genesee Ave
La Jolla, CA 92037-1223

Phone

(619) 277-9887

Fax

(801) 253-9831

NPI assigned

Jul 20, 2006

Last updated

Mar 4, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Shelly Lynn Daugherty

Title

Office Manager

Phone

(619) 277-9887

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1629098520",
    "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": "9834 GENESEE AVE",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371223",
            "telephone_number": "619-277-9887",
            "fax_number": "801-253-9831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES V. ETTARI, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "DAUGHERTY",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "619-277-9887",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G16786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOG167860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Lee Chao, M.D.
• Rambod Charepoo, M.D.
• Madeline Joan Charette
• Jason Anthony Charlebois, ATC
• Charles E Hollingsworth MD a Professional Corporation
• Cynthia Bajada Chasan, MD
• Edward Chau
• Kulreet K Chaudhary, MD
• Alexa Chavez, MD
• Denise April Chavira, PHD

• 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 Mar 4, 2015; 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.