MEDICARE: RICHARD FELTMAN PH.D.

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
1	103TC0700X	Clinical Psychologist	PSY9754	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY097540	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1265499412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD FELTMAN PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 16374
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92176-6374
Country	:	US
Telephone Number	:	858-576-3855
Fax Number	:	858-576-3855

Provider Business Practice Location Address
First Line	:	2423 CAMINO DEL RIO S
Second Line	:	STE 207
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3735
Country	:	US
Telephone Number	:	858-576-3855
Fax Number	:	858-576-3855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	08/02/2018

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