Healthcare Provider Details

I. General information

NPI: 1689734907
Provider Name (Legal Business Name): MICHAEL SESKIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 EL CAMINO REAL STE 305
SAN DIEGO CA
92130-3085
US

IV. Provider business mailing address

12395 EL CAMINO REAL STE 305
SAN DIEGO CA
92130-3085
US

V. Phone/Fax

Practice location:
  • Phone: 858-523-1035
  • Fax: 858-523-1037
Mailing address:
  • Phone: 858-523-1035
  • Fax: 858-523-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY6891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: