Provider Demographics
NPI:1225190085
Name:SACHS, BRUCE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:SACHS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16776 BERNARDO CENTER DR STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2559
Mailing Address - Country:US
Mailing Address - Phone:858-674-6441
Mailing Address - Fax:858-674-6491
Practice Address - Street 1:16776 BERNARDO CENTER DR STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2559
Practice Address - Country:US
Practice Address - Phone:858-674-6441
Practice Address - Fax:858-674-6491
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14629103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT14629AMedicare ID - Type Unspecified