Provider Demographics
NPI:1003105784
Name:KOGAN-SBARBARO, LINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:
Last Name:KOGAN-SBARBARO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LINA
Other - Middle Name:
Other - Last Name:KOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1050 UNIVERSITY AVE STE E107
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3359
Mailing Address - Country:US
Mailing Address - Phone:858-504-7743
Mailing Address - Fax:858-216-1928
Practice Address - Street 1:1050 UNIVERSITY AVE STE E107
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3359
Practice Address - Country:US
Practice Address - Phone:858-504-7743
Practice Address - Fax:858-216-1928
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31866103TC0700X
CA31886103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical