Healthcare Provider Details

I. General information

NPI: 1942517909
Provider Name (Legal Business Name): EMMANUEL PETER ESPEJO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR 116B
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

8685 RIO SAN DIEGO DR APT. # 4209
SAN DIEGO CA
92108-6551
US

V. Phone/Fax

Practice location:
  • Phone: 858-344-4458
  • Fax: 858-552-7414
Mailing address:
  • Phone: 310-922-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: