Healthcare Provider Details

I. General information

NPI: 1437568151
Provider Name (Legal Business Name): AMORSOLO BALMEO FERNANDO JR. PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31573 RANCHO PUEBLO RD STE 200
TEMECULA CA
92592-4854
US

IV. Provider business mailing address

31573 RANCHO PUEBLO RD STE 200
TEMECULA CA
92592-4854
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: