Healthcare Provider Details

I. General information

NPI: 1376775619
Provider Name (Legal Business Name): ROBERT GEFFNER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 OLD GROVE RD SUITE 101
SAN DIEGO CA
92131-1664
US

IV. Provider business mailing address

10065 OLD GROVE RD SUITE 101
SAN DIEGO CA
92131-1664
US

V. Phone/Fax

Practice location:
  • Phone: 858-527-1860
  • Fax:
Mailing address:
  • Phone: 858-527-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY16109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: