Provider Demographics
NPI:1669409140
Name:YANOFSKY, BRUCE (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:YANOFSKY
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 1:900 LANE AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4515
Mailing Address - Country:US
Mailing Address - Phone:619-240-3377
Mailing Address - Fax:
Practice Address - Street 1:900 LANE AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4515
Practice Address - Country:US
Practice Address - Phone:619-240-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17793Medicare ID - Type UnspecifiedINDIVIDUAL