DR. MICHAEL KORNBERG (NPI# 1174786834) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174786834 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL KORNBERG |
| Credential | M.D. |
| Practice Address |
12625 High Bluff Dr Suite 305 San Diego CA 92130-2052 |
| Practice Telephone | 8582791223 |
| Practice Fax Number | 8585094789 |
| Mailing Telephone | 8582791223 |
| Mailing Fax Number | 8585094789 |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2010-06-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
A101909 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RADY CHILDREN'S HOSPITAL SAN DIEGO, OUTPATIENT PSYCHIATRY | 95-1691313 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063742856 | Michael Davin Kornberg | Psychiatry & Neurology | 1800 Orleans St, Zayed 6005, Baltimore, MD 21287-0010 | 2009-12-30 |
| Street Address |
12625 HIGH BLUFF DR SUITE 305 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92130-2052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902851900 | Lagasse Yates, Inc | Psychologist | 12625 High Bluff Dr, Suite 206, San Diego, CA 92130-2052 | 2006-05-24 |
| 1659877611 | Rachel Beaubier | Registered Nurse | 12625 High Bluff Dr, San Diego, CA 92130-2052 | 2018-03-30 |
| 1609284769 | Katie Tiemeyer | Speech-Language Pathologist | 12625 High Bluff Dr, Suite 105, San Diego, CA 92130-2052 | 2014-07-31 |
| 1386056240 | Caroline Morin | Psychiatry & Neurology | 12625 High Bluff Dr, Suite 305, San Diego, CA 92130-2052 | 2014-05-27 |
| 1598189375 | Botkiss Center for Tms Therapy | Psychiatry & Neurology | 12625 High Bluff Dr, Suite 312, San Diego, CA 92130-2052 | 2014-02-13 |
| 1760826705 | Deborah G Mishek | Pediatrics | 12625 High Bluff Dr, Suite 302, San Diego, CA 92130-2052 | 2013-04-22 |
| 1457604639 | Kris Gremillion | Speech-Language Pathologist | 12625 High Bluff Dr, Suite 113, San Diego, CA 92130-2052 | 2012-10-24 |
| 1477836856 | Jonathan Ortiz | Social Worker | 12625 High Bluff Dr, Suite 305, San Diego, CA 92130-2052 | 2011-09-22 |
| 1376830331 | Kimberly Ducker | Specialist/Technologist | 12625 High Bluff Dr, Suite #113, San Diego, CA 92130-2052 | 2011-06-28 |
| 1083948046 | Jacqueline Michelle Gamboa | Psychologist | 12625 High Bluff Dr, Suite 114, San Diego, CA 92130-2052 | 2009-09-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629692397 | Tlc Family Therapy | Marriage & Family Therapist | 5965 Village Way. Suite 105 #112, San Diego, CA 92130 | 2020-05-29 |
| 1447746169 | Jack Perlov | Psychiatry & Neurology | 3535 Caminito El Rincon, Unit 268, San Diego, CA 92130 | 2018-07-05 |
| 1326551003 | Theotokos, LLC | Pharmacy | 5550 Carmel Mountain Rd Ste 111, San Diego, CA 92130 | 2017-11-16 |
| 1154879146 | Halie Hommes | Occupational Therapist | 12250 El Camino Real Ste 250, San Diego, CA 92130 | 2016-09-19 |
| 1790232015 | Coastal Skin and Eye Institute, Inc. | Ophthalmology | 5550 Carmel Mountain Road, Suite 206, San Diego, CA 92130 | 2016-09-02 |
| 1720534951 | Nosti and Rygg Dental Corporation | Dentist | 5550 Carmel Mountain Road, Ste 200, San Diego, CA 92130 | 2016-08-28 |
| 1831644053 | Marco Savittieri | Dentist | 3715 Ruette De Vl, San Diego, CA 92130 | 2016-08-17 |
| 1336508621 | Discovery Practice Management, Inc | Psychiatric Residential Treatment Facility | 11455 Camino Real, Ste 360, San Diego, CA 92130 | 2016-02-16 |
| 1427434679 | Coast Pediatrics Carmel Valley | Pediatrics | 5965 Village Drive, Suite 201, San Diego, CA 92130 | 2015-08-10 |
| 1659753762 | T Sidal Dds Md Inc | Dentist | 12395 El Camino Real, Suite 304, Torrey Pines Oral & Maxillofacial Surgery, San Diego, CA 92130 | 2015-06-25 |
| Find all providers in zip 92130 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922428622 | Nicholas J. Perez | Psychiatry & Neurology | 2351 Cardinal Lane, Annex B, San Diego, CA 92123 | 2014-04-21 |
| 1326484437 | Emily Anne Troyer | Psychiatry & Neurology | 210 Dickinson St., Bldg. Ctf-a, Room 402, San Diego, CA 92103-0804 | 2013-05-15 |
| 1902011505 | Marguerite Emilie Van Remoortere | Psychiatry & Neurology | 4660 Palm Avenue, Bldg A Scpmg, San Diego, CA 92154 | 2007-05-14 |
| 1841375458 | Aneita G Rashford | Psychiatry & Neurology | 3603 State St, 2, San Diego, CA 92103-4755 | 2006-10-25 |
| 1477635738 | Karen E Solway | Psychiatry & Neurology | 3020 Childrens Way # Mc5108, San Diego, CA 92123-4223 | 2006-10-19 |
| 1396847299 | Joan Sandra Gildin | Psychiatry & Neurology | 9400 Ruffin Ct, B, San Diego, CA 92123-5300 | 2006-09-01 |
| 1083728422 | Joseph Robert Mawhinney | Psychiatry & Neurology | 1959 Grand Ave, Suite A, San Diego, CA 92109-4511 | 2006-08-19 |
| 1417984949 | Renu Vishwanath Kaushik | Psychiatry & Neurology | 2801 Meadowlark Drive, San Diego, CA 92123 | 2006-06-28 |
| 1679510465 | Fee Sean Jane Chin | Psychiatry & Neurology | 6386 Alvarado Ct Ste 210, San Diego, CA 92120-4907 | 2006-06-01 |
| 1578537494 | Thomas Edward Deblois | Psychiatry & Neurology | 4452 Park Blvd., Ste. #214, San Diego, CA 92116-4049 | 2006-02-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.