Healthcare Provider Details

I. General information

NPI: 1962401919
Provider Name (Legal Business Name): STEVE KUDLER PSY.D, FPPR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22110 ROSCOE BLVD STE 300
CANOGA PARK CA
91304-3837
US

IV. Provider business mailing address

PO BOX 6393
WOODLAND HILLS CA
91365-6393
US

V. Phone/Fax

Practice location:
  • Phone: 818-582-6444
  • Fax:
Mailing address:
  • Phone: 818-582-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: