Healthcare Provider Details

I. General information

NPI: 1548380389
Provider Name (Legal Business Name): GINA WOLTMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 300
BURBANK CA
91505-4556
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 300
BURBANK CA
91505-4556
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY14859
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number14859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: