Healthcare Provider Details

I. General information

NPI: 1356742993
Provider Name (Legal Business Name): MATTHEW AVRUM SEITMAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 CAMINO DEL RIO S STE 303
SAN DIEGO CA
92108-3729
US

IV. Provider business mailing address

5557 FORBES AVE
SAN DIEGO CA
92120-1803
US

V. Phone/Fax

Practice location:
  • Phone: 619-635-2634
  • Fax: 619-632-5001
Mailing address:
  • Phone: 619-635-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY34512
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: