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Provider Information for 1598900367


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Dr. JOHN BOWERS MANSDORFER Ph.D.


Sex: Male

NPI: 1598900367
Last Updated: 2008-12-09
Certification Date:

Details

NameValue
NPI1598900367
Enumeration Date2008-12-09
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 785 GRAND AVE
SUITE 219
CARLSBAD, CA 92008-2370
United States

Phone: 760-729-6009 | Fax:760-729-6009
 
Primary Practice Address 785 GRAND AVE
SUITE 219
CARLSBAD, CA 92008-2370
United States

Phone: 760-729-6009 | Fax:760-729-6009
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 103TC0700X - Psychologist - ClinicalCApsy13625