Healthcare Provider Details

I. General information

NPI: 1073557476
Provider Name (Legal Business Name): STUART KIRSCHBAUM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27001 LA PAZ RD SUITE 418
MISSION VIEJO CA
92691-5502
US

IV. Provider business mailing address

27001 LA PAZ RD SUITE 418
MISSION VIEJO CA
92691-5502
US

V. Phone/Fax

Practice location:
  • Phone: 949-215-2500
  • Fax: 949-203-8686
Mailing address:
  • Phone: 949-215-2500
  • Fax: 949-203-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: