Healthcare Provider Details

I. General information

NPI: 1215174511
Provider Name (Legal Business Name): RICHARD F OELBERGER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S MAPLE ST
LOS ANGELES CA
90013
US

IV. Provider business mailing address

529 S MAPLE ST
LOS ANGELES CA
90013
US

V. Phone/Fax

Practice location:
  • Phone: 310-490-6733
  • Fax: 213-895-6266
Mailing address:
  • Phone: 310-490-6733
  • Fax: 213-895-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 22186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: