Provider Demographics
NPI:1083789119
Name:DEL MAR PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:DEL MAR PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-523-9409
Mailing Address - Street 1:1343 STRATFORD COURT
Mailing Address - Street 2:DEL MAR PSYCHIATRIC CENTER
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014
Mailing Address - Country:US
Mailing Address - Phone:858-523-9409
Mailing Address - Fax:858-523-9403
Practice Address - Street 1:1343 STRATFORD COURT
Practice Address - Street 2:DEL MAR PSYCHIATRIC CENTER
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014
Practice Address - Country:US
Practice Address - Phone:858-523-9409
Practice Address - Fax:858-523-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG852402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F13103Medicare UPIN
W15668Medicare ID - Type Unspecified