Provider Demographics
NPI:1154541852
Name:FOSTER, ELOISE VERING (PHD)
Entity type:Individual
Prefix:DR
First Name:ELOISE
Middle Name:VERING
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4111
Mailing Address - Country:US
Mailing Address - Phone:619-299-8280
Mailing Address - Fax:619-542-0324
Practice Address - Street 1:3707 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4111
Practice Address - Country:US
Practice Address - Phone:619-299-8280
Practice Address - Fax:619-542-0324
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17446Medicare ID - Type UnspecifiedPROVIDER NUMBER