Healthcare Provider Details

I. General information

NPI: 1619412806
Provider Name (Legal Business Name): WAVES, A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 POMERADO RD SUITE C-5
POWAY CA
92064-2435
US

IV. Provider business mailing address

15525 POMERADO RD SUITE C-5
POWAY CA
92064-2435
US

V. Phone/Fax

Practice location:
  • Phone: 619-403-5578
  • Fax: 866-273-9073
Mailing address:
  • Phone: 619-403-5578
  • Fax: 866-273-9073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 27497
License Number StateCA

VIII. Authorized Official

Name: DR. ABIGAIL WEISSMAN
Title or Position: CHAIRWOMAN AND PSYCHOLOGIST
Credential: PSY.D.
Phone: 619-403-5578