Provider Demographics
NPI:1295373918
Name:SAINT JOSEPH PSYCHOLOGICAL CLINIC INC
Entity Type:Organization
Organization Name:SAINT JOSEPH PSYCHOLOGICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTERO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-507-9294
Mailing Address - Street 1:4415 POMONA AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9118
Mailing Address - Country:US
Mailing Address - Phone:619-507-9294
Mailing Address - Fax:
Practice Address - Street 1:3252 HOLIDAY CT STE 205
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1808
Practice Address - Country:US
Practice Address - Phone:619-507-9294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty