Healthcare Provider Details

I. General information

NPI: 1164751368
Provider Name (Legal Business Name): GORDON M ZILBERMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 05/06/2024
Certification Date: 04/25/2024
Deactivation Date: 06/16/2010
Reactivation Date: 03/22/2016

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

200 MERCY CIRCLE
OCEANSIDE CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3581
  • Fax:
Mailing address:
  • Phone: 760-716-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14217
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY14217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: