Healthcare Provider Details

I. General information

NPI: 1104975028
Provider Name (Legal Business Name): MICHAEL EPSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HIGH BLUFF DR STE 216
SAN DIEGO CA
92130-2054
US

IV. Provider business mailing address

7506 GARDEN TER APT 201
SAN DIEGO CA
92127-3611
US

V. Phone/Fax

Practice location:
  • Phone: 619-952-5321
  • Fax:
Mailing address:
  • Phone: 619-952-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number33435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: