Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 31181 | CA |
Y | 103T00000X | Psychologist | 31181 | CA |
N | 103G00000X | Clinical Psychologist | 31181 | CA |
N | 103TC0700X | Clinical Psychologist | 31181 | CA |
NPI | 1003246364 |
---|---|
Provider Name | Dr. Rodger Stacy Questin |
First Address | San Diego, CA 92103-4203 |
Second Address | San Diego, CA 92103-4203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2013 |
Last Update Date | 24/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01261511 | (05) | CA |