Healthcare Provider Details

I. General information

NPI: 1326373499
Provider Name (Legal Business Name): ERIC JOHN KLOEPPEL PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/28/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST MERCY CIRCLE
OCEANSIDE CA
92055
US

IV. Provider business mailing address

1315 GREENLAKE DR
CARDIFF BY THE SEA CA
92007-1022
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3312
  • Fax:
Mailing address:
  • Phone: 714-655-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1678
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: