Provider Demographics
NPI:1760631899
Name:SCHWARTZ, DEREK TODD (PHD, BCIAC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:TODD
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PHD, BCIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8813 VILLA LA JOLLA DR
Mailing Address - Street 2:STE. 2002
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1937
Mailing Address - Country:US
Mailing Address - Phone:858-877-0770
Mailing Address - Fax:858-452-1517
Practice Address - Street 1:8813 VILLA LA JOLLA DR
Practice Address - Street 2:STE. 2002
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1937
Practice Address - Country:US
Practice Address - Phone:858-877-0770
Practice Address - Fax:858-452-1517
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22176103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ843Medicare PIN