Provider Demographics
NPI:1881949048
Name:LOWE, IAN J E Q (PSYD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:J E Q
Last Name:LOWE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 BALBOA AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6935
Mailing Address - Country:US
Mailing Address - Phone:619-949-8994
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6935
Practice Address - Country:US
Practice Address - Phone:619-949-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical