Healthcare Provider Details

I. General information

NPI: 1417027483
Provider Name (Legal Business Name): ROBERTO NETTER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 HOLIDAY CT STE. 100
LA JOLLA CA
92037-0027
US

IV. Provider business mailing address

PO BOX 13034
LA JOLLA CA
92039-3034
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8911
  • Fax: 858-793-5492
Mailing address:
  • Phone: 858-552-8911
  • Fax: 858-793-5492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY11951
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY11951
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11951
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY11951
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY11951
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY11951
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY11951
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY11951
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY1951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: