MEDICARE: DR. CHRISTAURIA GILLIAN WELLAND-AKONG PSY.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	PSY 17166	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 17166	CA
3	103T00000X	Psychologist	PSY 17166	CA
4	103TR0400X	Rehabilitation Psychologist	PSY 17166	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326099318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTAURIA GILLIAN WELLAND-AKONG PSY.D.

Provider Business Mailing Address
First Line	:	14356 MARIANOPOLIS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-4316
Country	:	US
Telephone Number	:	858-922-8555
Fax Number	:	858-484-7514

Provider Business Practice Location Address
First Line	:	990 HIGHLAND DR
Second Line	:	#103
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-2408
Country	:	US
Telephone Number	:	858-922-8555
Fax Number	:	858-484-7514

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	02/02/2010

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