Basic Information
Provider Information | |||||||||
NPI: | 1073815072 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HANSON BONDI | ||||||||
FirstName: | KAREN | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HANSON | ||||||||
OtherFirstName: | KAREN | ||||||||
OtherMiddleName: | LEE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PH.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3350 LA JOLLA VILLAGE DR | ||||||||
Address2: | 151B | ||||||||
City: | SAN DIEGO | ||||||||
State: | CA | ||||||||
PostalCode: | 921610002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8585528585 | ||||||||
FaxNumber: | 8586426340 | ||||||||
Practice Location | |||||||||
Address1: | 3350 LA JOLLA VILLAGE DR | ||||||||
Address2: | 151B | ||||||||
City: | SAN DIEGO | ||||||||
State: | CA | ||||||||
PostalCode: | 921610002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8585528585 | ||||||||
FaxNumber: | 8586426340 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/23/2010 | ||||||||
LastUpdateDate: | 11/23/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | PSY23561 | CA | Y |   | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |   |
No ID Information.