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NPI Code Detail

MEDICARE: STEPHANIE KNATZ PECK PH.D.

MEDICARE: STEPHANIE KNATZ PECK 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
1103T00000XPsychologistPSY26162CA

General Provider Information

NPI Number : 1417106899
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE KNATZ PECK PH.D.
Provider Business Mailing Address
First Line : PO BOX 232410
Second Line :
City : SAN DIEGO
State : CA
Zip : 92193-2410
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1010 TURQUOISE ST STE 303
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-1268
Country : US
Telephone Number : 858-255-4095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2008
Last Update Date : 03/16/2026

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