Healthcare Provider Details

I. General information

NPI: 1649498536
Provider Name (Legal Business Name): OREN DAVID WUNDERMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 SOUTHWEST 57TH AVE. SUITE 222
SOUTH MIAMI FL
33143
US

IV. Provider business mailing address

7600 SOUTHWEST 57TH. AVE. SUITE 222
SOUTH MIAMI FL
33143
US

V. Phone/Fax

Practice location:
  • Phone: 786-236-0573
  • Fax: 305-385-7164
Mailing address:
  • Phone: 786-236-0573
  • Fax: 305-385-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: