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General NPI Number Information
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NPI Number | 1669698908
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Entity Type | Organization
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Legal Business Name | JOHN B. MANSDORFER, PH.D.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 785 GRAND AVE 219
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City | CARLSBAD
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State | CA
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Zip | 92008-2370
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Country | US
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Telephone | 760-729-6009
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Fax | 760-729-6009
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Provider Business Mailing Address
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Address Line | 785 GRAND AVE 219
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City | CARLSBAD
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State | CA
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Zip | 92008-2370
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Country | US
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Telephone | 760-729-6009
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Fax | 760-729-6009
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JOHN B MANSDORFER
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Credential | PH.D.
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Telephone | 760-729-6009
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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 | PSY13625
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License Number State | CA
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