Provider Demographics
NPI:1861678633
Name:EBBERS, DOUGLAS P (MS IN ED)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:EBBERS
Suffix:
Gender:M
Credentials:MS IN ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CHILDREN'S WAY
Mailing Address - Street 2:MC 5111
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4282
Mailing Address - Country:US
Mailing Address - Phone:858-966-1700
Mailing Address - Fax:858-966-7521
Practice Address - Street 1:3665 KEARNY VILLA RD
Practice Address - Street 2:SUITE 405
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1953
Practice Address - Country:US
Practice Address - Phone:858-966-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist