Provider Demographics
NPI:1568849214
Name:PACIFIC PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:PACIFIC PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:KIM AJLOUNY, PSY.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CIINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:AJLOUNY
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-229-6986
Mailing Address - Street 1:2351 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2009
Mailing Address - Country:US
Mailing Address - Phone:858-229-6986
Mailing Address - Fax:858-712-3881
Practice Address - Street 1:265 SANTA HELENA STE 214
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075
Practice Address - Country:US
Practice Address - Phone:858-480-1661
Practice Address - Fax:858-712-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23171103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB234246OtherMEDICARE PTAN
CACW586AOtherMEDICARE PTAN
CAW416Medicare PIN