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General NPI Number Information
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NPI Number | 1659305613
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Entity Type | Organization
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Legal Business Name | MICHAEL R. REIDER, PH.D., APC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 9750 MIRAMAR ROAD SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92126-4562
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Country | US
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Telephone | 888-293-3182
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Fax | 888-293-3182
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Provider Business Mailing Address
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Address Line | 9750 MIRAMAR ROAD SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92126-4562
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Country | US
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Telephone | 888-293-3182
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Fax | 888-293-3182
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/CEO
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Name | DR. MICHAEL ROBERT REIDER
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Credential | PH.D.
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Telephone | 888-293-3182
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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 | PSY13784
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License Number State | CA
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