MEDICARE: DR. MARK G WIESNER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	5996	CA

General Provider Information

NPI Number	:	1205072931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK G WIESNER PH.D.

Provider Business Mailing Address
First Line	:	5677 OBERLIN DR STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1741
Country	:	US
Telephone Number	:	858-457-8419
Fax Number	:	858-457-0670

Provider Business Practice Location Address
First Line	:	5677 OBERLIN DR STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1741
Country	:	US
Telephone Number	:	858-457-8419
Fax Number	:	858-457-0670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	12/30/2008

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1548473622 — BECKY D. HALY L.AC. M.S.
Practice Location Address:

5677 OBERLIN DR STE 112
SAN DIEGO, CA
92121-1741

Practice Phone: 619-303-7400
Practice Fax: 619-460-6316

1689997769 — MS. KATHERINE BAUER DAHL DPT
Practice Location Address:

5677 OBERLIN DR STE 106
SAN DIEGO, CA
92121-1741

Practice Phone: 858-457-8419
Practice Fax:

1699348789 — CHRISTIAN PEDRETTI L.AC.
Practice Location Address:

5677 OBERLIN DR STE 112
SAN DIEGO, CA
92121-1741

Practice Phone: 619-750-0488
Practice Fax:

1851091243 — JILIAN BINUYA
Practice Location Address:

5677 OBERLIN DR STE 106
SAN DIEGO, CA
92121-1741

Practice Phone: 858-457-8419
Practice Fax: 858-457-0670

1245930643 — DANIELLE EUZENT PT, DPT
Practice Location Address:

5677 OBERLIN DR STE 106
SAN DIEGO, CA
92121-1741

Practice Phone: 858-457-8419
Practice Fax: 858-457-0670

Directions to “ DR. MARK G WIESNER PH.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.