Provider Information for 1629596309
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Dr. JARED WILKE Psy.D.
Sex: Male
NPI: 1629596309
Last Updated: 2017-09-01
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1629596309 | ||||||||
| Enumeration Date | 2017-09-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 11440 W BERNARDO CT STE 272 SAN DIEGO, CA 92127-1643 United States Phone: 858-592-0995 | Fax: | ||||||||
| Primary Practice Address | 11440 W BERNARDO CT STE 272 SAN DIEGO, CA 92127-1643 United States Phone: 858-592-0995 | Fax: | ||||||||
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