Provider Demographics
NPI:1629143292
Name:BERNABO & HOGAN PSYCHOLOGICAL CORP.
Entity Type:Organization
Organization Name:BERNABO & HOGAN PSYCHOLOGICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-656-3775
Mailing Address - Street 1:1415 RIDGEBACK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6932
Mailing Address - Country:US
Mailing Address - Phone:619-656-3775
Mailing Address - Fax:858-549-3146
Practice Address - Street 1:1415 RIDGEBACK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6932
Practice Address - Country:US
Practice Address - Phone:619-656-3775
Practice Address - Fax:858-549-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881688000OtherDR. HOGAN NPI
CA1942220801OtherDR. BERNABO NPI