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General NPI Number Information
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NPI Number | 1992147680
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Entity Type | Individual
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Provider Name | ELIZABETH POULSEN WIEGAND PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 3609 OCEAN RANCH BLVD STE 208&209
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City | OCEANSIDE
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State | CA
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Zip | 92056-2698
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Country | US
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Telephone | 858-279-1223
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Fax | 858-467-7161
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Provider Business Mailing Address
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Address Line | 3609 OCEAN RANCH BLVD STE 208&209
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City | OCEANSIDE
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State | CA
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Zip | 92056-2698
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Country | US
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Telephone | 858-279-1223
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Fax | 858-467-7161
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 29333
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License Number State | CA
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