Healthcare Provider Details

I. General information

NPI: 1689664278
Provider Name (Legal Business Name): MARK SCHINDLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7486 LA JOLLA BLVD STE 500
LA JOLLA CA
92037-5029
US

IV. Provider business mailing address

7486 LA JOLLA BLVD STE 500
LA JOLLA CA
92037-5029
US

V. Phone/Fax

Practice location:
  • Phone: 858-488-5554
  • Fax: 858-488-5545
Mailing address:
  • Phone: 858-488-5554
  • Fax: 858-488-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: