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NPI Code Detail

MEDICARE: DR. KATHY ANN VANDENBURGH PH.D.

MEDICARE: DR. KATHY ANN VANDENBURGH 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
1103TC0700XClinical PsychologistPSY14408CA

General Provider Information

NPI Number : 1760537328
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHY ANN VANDENBURGH PH.D.
Provider Business Mailing Address
First Line : 10755 SCRIPPS POWAY PKWY STE F
Second Line : PMB # 137
City : SAN DIEGO
State : CA
Zip : 92131-3924
Country : US
Telephone Number : 858-486-7345
Fax Number :
Provider Business Practice Location Address
First Line : 6160 CORNERSTONE CT E
Second Line : SUITE 155
City : SAN DIEGO
State : CA
Zip : 92121-3720
Country : US
Telephone Number : 858-642-0267
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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