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General NPI Number Information
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NPI Number | 1346526274
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Entity Type | Individual
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Provider Name | RUSSELL WILLIAM DEHNEL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 5952 EL CAJON BLVD
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City | SAN DIEGO
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State | CA
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Zip | 92115-3828
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Country | US
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Telephone | 619-286-9052
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Fax | 619-286-9053
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Provider Business Mailing Address
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Address Line | 11940 ROCOSO RD
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City | LAKESIDE
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State | CA
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Zip | 92040-1038
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Country | US
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Telephone | 619-402-7305
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 12603
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License Number State | CA
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