Healthcare Provider Details

I. General information

NPI: 1972659761
Provider Name (Legal Business Name): MICHAEL GENE ONDRUSEK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 HOLIDAY CT STE 107
LA JOLLA CA
92037-1807
US

IV. Provider business mailing address

2329 LORING ST
SAN DIEGO CA
92109-2346
US

V. Phone/Fax

Practice location:
  • Phone: 858-449-8788
  • Fax: 858-273-5657
Mailing address:
  • Phone: 858-449-8788
  • Fax: 858-273-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY8461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: