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General NPI Number Information
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NPI Number | 1891287678
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD BUCKLE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 401 QUARRY RD
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City | PALO ALTO
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State | CA
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Zip | 94304-1419
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Country | US
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Telephone | 650-743-3269
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Fax |
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Provider Business Mailing Address
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Address Line | 2156 GREENWOOD AVE
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City | SAN CARLOS
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State | CA
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Zip | 94070-4502
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Country | US
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Telephone | 650-743-3269
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Fax |
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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 | 30518
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License Number State | CA
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