Healthcare Provider Details

I. General information

NPI: 1982907424
Provider Name (Legal Business Name): PAUL KREBS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 4TH AVE STE 5
SAN DIEGO CA
92103-4118
US

IV. Provider business mailing address

2017 LAPEYROUSE ST
NEW ORLEANS LA
70116-1742
US

V. Phone/Fax

Practice location:
  • Phone: 646-820-7477
  • Fax:
Mailing address:
  • Phone: 646-820-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number018694
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY32156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: