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General NPI Number Information
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NPI Number | 1497901391
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Entity Type | Organization
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Legal Business Name | KIRK R. WACHTMANN, PH.D., APC
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 4060 FOURTH AVE SUITE 615
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City | SAN DIEGO
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State | CA
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Zip | 92103-2116
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Country | US
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Telephone | 619-977-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 4060 FOURTH AVE SUITE 615
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City | SAN DIEGO
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State | CA
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Zip | 92103-2116
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Country | US
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Telephone | 619-977-6007
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIRK ROBERT WACHTMANN
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Credential | PH.D.
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Telephone | 619-977-6007
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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 | PSY5830
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License Number State | CA
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