MEDICARE: SPENCER WETTER 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	103G00000X	Clinical Neuropsychologist	20501	CA

General Provider Information

NPI Number	:	1629264130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER WETTER PH.D.

Provider Business Mailing Address
First Line	:	9648 CAMINITO DEL FELIZ
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1903
Country	:	US
Telephone Number	:	858-752-2329
Fax Number	:

Provider Business Practice Location Address
First Line	:	9648 CAMINITO DEL FELIZ
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1903
Country	:	US
Telephone Number	:	858-752-2329
Fax Number	:

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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