Healthcare Provider Details

I. General information

NPI: 1598900367
Provider Name (Legal Business Name): JOHN B MANSDORFER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN B MANSDORFER PH D INC PHD

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 CRANE AVE
ESCONDIDO CA
92027-6218
US

IV. Provider business mailing address

3271 CRANE AVE
ESCONDIDO CA
92027-6218
US

V. Phone/Fax

Practice location:
  • Phone: 760-822-2726
  • Fax:
Mailing address:
  • Phone: 760-822-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: