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General NPI Number Information
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NPI Number | 1548361744
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Entity Type | Individual
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Provider Name | WILLIAM MICHAEL BROCK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 3435 CAMINO DEL RIO S SUITE 205
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City | SAN DIEGO
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State | CA
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Zip | 92108-3902
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Country | US
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Telephone | 619-665-2125
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Fax | 619-528-8350
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Provider Business Mailing Address
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Address Line | 3401 ADAMS AVE A174
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City | SAN DIEGO
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State | CA
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Zip | 92116-2490
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Country | US
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Telephone | 619-665-2125
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Fax | 619-528-8350
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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 | PSY8466
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License Number State | CA
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