Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY5995 | CA |
N | 103G00000X | Clinical Psychologist | PSY5995 | CA |
N | 103TC0700X | Clinical Psychologist | PSY5995 | CA |
NPI | 1235100959 |
---|---|
Provider Name | Dr. Gerald Allen Vernon |
First Address | Del Mar, CA 92014-2924 |
Second Address | San Diego, CA 92106-4408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/07/2007 |