| Sdpc | |
|
15525 Pomerado Rd Suite B3 Poway CA 92064-2435 | |
| (760) 607-6463 | |
| (760) 607-3433 |
| Full Name | Sdpc |
|---|---|
| Speciality | Psychologist |
| Location | 15525 Pomerado Rd, Poway, California |
| Authorized Official Name and Position | Banafsheh Pezeshk (CEO) |
| Authorized Official Contact | 7606076463 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sdpc 2258 Sunset Dr Escondido CA 92025-6613 Ph: (760) 607-6463 | Sdpc 15525 Pomerado Rd Suite B3 Poway CA 92064-2435 Ph: (760) 607-6463 |
| NPI Number | 1083003586 |
|---|---|
| Provider Enumeration Date | 01/21/2015 |
| Last Update Date | 10/09/2021 |
| Certification Date | 10/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083003586 | NPI | - | NPPES |
| 1184959009 | Other | CA | PERSONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 22844 (California) | Primary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
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