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General NPI Number Information
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NPI Number | 1720175748
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Entity Type | Individual
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Provider Name | DOUGLAS DRUCKER PHD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 12/22/2012
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Provider Practice Location Address
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Address Line | 16615 LARK AVE STE 203
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City | LOS GATOS
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State | CA
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Zip | 95032-7645
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Country | US
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Telephone | 408-358-8792
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Fax | 408-358-8762
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Provider Business Mailing Address
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Address Line | 3803 S BASCOM AVE STE 210
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City | CAMPBELL
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State | CA
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Zip | 95008-7317
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Country | US
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Telephone | 408-377-3510
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Fax | 408-377-2941
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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 | PSY14138
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License Number State | CA
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