MEDICARE: DR. ROBERT JOSEPH GOTTLIEB 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	PSY11920	CA

General Provider Information

NPI Number	:	1972694610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOSEPH GOTTLIEB PH.D.

Provider Business Mailing Address
First Line	:	9663 TIERRA GRANDE ST
Second Line	:	SUITE 104
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4569
Country	:	US
Telephone Number	:	858-695-2243
Fax Number	:	858-452-2725

Provider Business Practice Location Address
First Line	:	9663 TIERRA GRANDE ST
Second Line	:	SUITE 104
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4569
Country	:	US
Telephone Number	:	858-695-2243
Fax Number	:	858-452-2725

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/08/2016

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