Provider Demographics
NPI:1972713063
Name:BOGDONOFF, DRUE ALDEN (PHD, SEP, MBA)
Entity type:Individual
Prefix:DR
First Name:DRUE
Middle Name:ALDEN
Last Name:BOGDONOFF
Suffix:
Gender:F
Credentials:PHD, SEP, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 IVANHOE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4501
Mailing Address - Country:US
Mailing Address - Phone:858-535-0664
Mailing Address - Fax:858-535-1029
Practice Address - Street 1:7820 IVANHOE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4501
Practice Address - Country:US
Practice Address - Phone:858-535-0664
Practice Address - Fax:858-535-1029
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19786102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst