Healthcare Provider Details

I. General information

NPI: 1346271079
Provider Name (Legal Business Name): RICHARD NEIL GEVIRTZ PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 POMERADO
SAN DIEGO CA
92131
US

IV. Provider business mailing address

10455 POMERADO
SAN DIEGO CA
92131
US

V. Phone/Fax

Practice location:
  • Phone: 858-635-4842
  • Fax: 858-635-4482
Mailing address:
  • Phone: 858-635-4842
  • Fax: 858-635-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7204
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY7204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: