Healthcare Provider Details

I. General information

NPI: 1336277763
Provider Name (Legal Business Name): WANDA VON KLEIST, PH.D. & ASSOCIATES, A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W COAST HWY STE 500
NEWPORT BEACH CA
92663-4043
US

IV. Provider business mailing address

3333 W COAST HWY STE 500
NEWPORT BEACH CA
92663-4043
US

V. Phone/Fax

Practice location:
  • Phone: 949-903-1481
  • Fax: 949-646-6678
Mailing address:
  • Phone: 949-903-1481
  • Fax: 949-646-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number19430
License Number StateCA

VIII. Authorized Official

Name: DR. WANDA VON KLEIST
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 949-903-1481