Provider Demographics
NPI:1407983679
Name:MAURO, PATRICIA ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:MAURO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 TORREJON PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8034
Mailing Address - Country:US
Mailing Address - Phone:760-942-6320
Mailing Address - Fax:
Practice Address - Street 1:5850 OBERLIN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4719
Practice Address - Country:US
Practice Address - Phone:858-535-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical