Provider Demographics
NPI:1124699236
Name:SD PSYCHOLOGY, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SD PSYCHOLOGY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STAMATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAROGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-894-1507
Mailing Address - Street 1:PO BOX 1521
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-1521
Mailing Address - Country:US
Mailing Address - Phone:619-894-1507
Mailing Address - Fax:
Practice Address - Street 1:7946 IVANHOE AVE STE 310
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4518
Practice Address - Country:US
Practice Address - Phone:619-894-1507
Practice Address - Fax:858-346-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205179322OtherNPI (INDIVIDUAL)