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General NPI Number Information
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NPI Number | 1073576690
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Entity Type | Individual
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Provider Name | PAUL DOUGLAS WYATT ED.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 828 UNIVERSITY AVE
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City | SACRAMENTO
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State | CA
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Zip | 95825-6723
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Country | US
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Telephone | 916-565-1919
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Fax | 916-488-2919
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Provider Business Mailing Address
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Address Line | 2271 UNIVERSITY AVE
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City | SACRAMENTO
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State | CA
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Zip | 95825-7083
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Country | US
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Telephone | 916-488-2919
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Fax | 916-488-2919
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 3094
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License Number State | CA
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