Provider Demographics
NPI:1770898298
Name:CENTRO DE PSICOLOGIA CULTURAL, INC
Entity type:Organization
Organization Name:CENTRO DE PSICOLOGIA CULTURAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CARBONELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-282-4270
Mailing Address - Street 1:6136 MISSION GORGE RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3494
Mailing Address - Country:US
Mailing Address - Phone:619-282-4270
Mailing Address - Fax:619-282-4272
Practice Address - Street 1:6136 MISSION GORGE RD
Practice Address - Street 2:SUITE 129
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3494
Practice Address - Country:US
Practice Address - Phone:619-282-4270
Practice Address - Fax:619-282-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty