Healthcare Provider Details

I. General information

NPI: 1730239914
Provider Name (Legal Business Name): PAUL ROHDE HEBERLEIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 MERIDIAN AVE STE 150
SAN JOSE CA
95125-4352
US

IV. Provider business mailing address

1118 MERIDIAN AVE STE 150
SAN JOSE CA
95125-4352
US

V. Phone/Fax

Practice location:
  • Phone: 408-445-8172
  • Fax: 408-266-6614
Mailing address:
  • Phone: 408-445-8172
  • Fax: 408-266-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY11450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: