Provider Demographics
NPI:1720013170
Name:LA JOLLA PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:LA JOLLA PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ZETUMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-452-9969
Mailing Address - Street 1:5190 GOVERNOR DR.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2846
Mailing Address - Country:US
Mailing Address - Phone:858-452-9969
Mailing Address - Fax:858-452-5729
Practice Address - Street 1:5190 GOVERNOR DR.
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2846
Practice Address - Country:US
Practice Address - Phone:858-452-9969
Practice Address - Fax:858-452-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW982Medicare PIN