Basic Information
| Provider Information | |||||||||
| NPI: | 1760699714 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHCOAST PSYCHOLOGICAL ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7373 UNIVERSITY AVE | ||||||||
| Address2: | 213 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919416000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194641165 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2011 PALOMAR AIRPORT RD | ||||||||
| Address2: | 205 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920111430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492480508 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RADOJEVIC | ||||||||
| AuthorizedOfficialFirstName: | VESNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9492480508 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.