Healthcare Provider Details

I. General information

NPI: 1114130978
Provider Name (Legal Business Name): ERICA WANDNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13666 EAST 14TH ST
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

13666 EAST 14TH ST
SAN LEANDRO CA
94578
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-5515
  • Fax: 510-357-5112
Mailing address:
  • Phone: 510-357-5515
  • Fax: 510-357-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 18200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: