Provider Demographics
NPI:1598189375
Name:BOTKISS CENTER FOR TMS THERAPY
Entity Type:Organization
Organization Name:BOTKISS CENTER FOR TMS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BOTKISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-291-7100
Mailing Address - Street 1:PO BOX 712878
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92171-2878
Mailing Address - Country:US
Mailing Address - Phone:619-294-4119
Mailing Address - Fax:619-295-5044
Practice Address - Street 1:12625 HIGH BLUFF DR
Practice Address - Street 2:SUITE 312
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2052
Practice Address - Country:US
Practice Address - Phone:619-291-7100
Practice Address - Fax:619-295-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA432732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43272Medicare UPIN