Healthcare Provider Details

I. General information

NPI: 1679596282
Provider Name (Legal Business Name): WENDI MAURER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 HOLIDAY CT SUITE 220
LA JOLLA CA
92037-0027
US

IV. Provider business mailing address

8813 VILLA LA JOLLA DR STE 2002
LA JOLLA CA
92037-1927
US

V. Phone/Fax

Practice location:
  • Phone: 619-491-3459
  • Fax: 858-453-8634
Mailing address:
  • Phone: 619-491-3459
  • Fax: 858-453-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 12694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: