Provider Demographics
NPI:1083122014
Name:DI TORO, BERNADETTE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:M
Last Name:DI TORO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2972
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-2972
Mailing Address - Country:US
Mailing Address - Phone:858-609-9173
Mailing Address - Fax:858-332-1748
Practice Address - Street 1:7440 GIRARD AVE STE 1
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5157
Practice Address - Country:US
Practice Address - Phone:858-609-9173
Practice Address - Fax:858-332-1748
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical