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NPI Code Detail

MEDICARE: OLIVIA S WETTER MS

MEDICARE:   OLIVIA S WETTER  MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool PsychologistNY

General Provider Information

NPI Number : 1205500428
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA S WETTER MS
Provider Business Mailing Address
First Line : 3172 ADAMS AVE APT E
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-1682
Country : US
Telephone Number : 845-728-1693
Fax Number :
Provider Business Practice Location Address
First Line : 3172 ADAMS AVE APT E
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-1682
Country : US
Telephone Number : 845-728-1693
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2021
Last Update Date : 08/02/2021

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Directions to “ OLIVIA S WETTER MS” Practice Location

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