=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326318346
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FREDRIC A SELDIN PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2012
-----------------------------------------------------
Last Update Date | 03/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7840 MISSION CENTER CT SUITE 102
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-813-5923
-----------------------------------------------------
Fax | 619-618-1795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7840 MISSION CENTER CT SUITE 102
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-813-5923
-----------------------------------------------------
Fax | 619-618-1795
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 20365
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------