Provider Demographics
NPI:1437613064
Name:INTEGRAMED SAN DIEGO
Entity Type:Organization
Organization Name:INTEGRAMED SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TABACARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-376-7796
Mailing Address - Street 1:7840 MISSION CENTER CT STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1321
Mailing Address - Country:US
Mailing Address - Phone:858-376-7796
Mailing Address - Fax:800-693-7058
Practice Address - Street 1:7840 MISSION CENTER CT STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1321
Practice Address - Country:US
Practice Address - Phone:858-376-7796
Practice Address - Fax:800-693-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730384181OtherINDIVIDUAL NPI BY NPPES