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NPI Code Detail

MEDICARE: DR. DEBORAH EILEEN WISS PHD

MEDICARE:  DR. DEBORAH EILEEN WISS  PHD
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
1103TC0700XClinical PsychologistPSY16592CA

General Provider Information

NPI Number : 1740454321
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBORAH EILEEN WISS PHD
Provider Business Mailing Address
First Line : 10444 SANTA MONICA BLVD
Second Line : SUITE 301
City : LOS ANGELES
State : CA
Zip : 90025-6959
Country : US
Telephone Number : 310-824-2155
Fax Number : 310-470-7969
Provider Business Practice Location Address
First Line : 10444 SANTA MONICA BLVD
Second Line : SUITE 301
City : LOS ANGELES
State : CA
Zip : 90025-6959
Country : US
Telephone Number : 310-824-2155
Fax Number : 310-470-7969
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2008
Last Update Date : 04/15/2008

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Directions to “ DR. DEBORAH EILEEN WISS PHD” Practice Location

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