Healthcare Provider Details

I. General information

NPI: 1407279656
Provider Name (Legal Business Name): KIRBY WOHLANDER M.SW., L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD STE 535
POWAY CA
92064-2437
US

IV. Provider business mailing address

15611 POMERADO RD STE 535
POWAY CA
92064-2437
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax: 858-679-8519
Mailing address:
  • Phone: 619-992-3290
  • Fax: 619-795-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 6835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: