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General NPI Number Information
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NPI Number | 1225162274
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Entity Type | Organization
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Legal Business Name | DANIEL BLAESS, PH.D., PSYCHOLOGIST, INC.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 1350 COLUMBIA ST UNIT 402
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City | SAN DIEGO
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State | CA
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Zip | 92101-3455
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Country | US
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Telephone | 619-804-1669
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Fax | 619-804-1669
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Provider Business Mailing Address
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Address Line | 1350 COLUMBIA ST UNIT 402
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City | SAN DIEGO
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State | CA
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Zip | 92101-3455
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Country | US
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Telephone | 619-804-1669
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Fax | 619-804-1669
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL BLAESS
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Credential | PH.D.
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Telephone | 619-804-1669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY17107
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License Number State | CA
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