Healthcare Provider Details

I. General information

NPI: 1033701552
Provider Name (Legal Business Name): RENEE A JOSEPH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

PO BOX 3173
SAN DIEGO CA
92163-1173
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7311
  • Fax:
Mailing address:
  • Phone: 347-513-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: