Provider Demographics
NPI:1881688000
Name:HOGAN, CHARLES ALVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALVIN
Last Name:HOGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 CAMINITO SANUDO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2103
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:
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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7029103TC0700X
CAEB1138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist