Provider Demographics
NPI:1609909191
Name:WROBEL, MICHAEL DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:WROBEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DRIVE
Mailing Address - Street 2:SUITE C113
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1703
Mailing Address - Country:US
Mailing Address - Phone:858-552-1499
Mailing Address - Fax:858-452-1517
Practice Address - Street 1:8950 VILLA LA JOLLA DRIVE
Practice Address - Street 2:SUITE C113
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1703
Practice Address - Country:US
Practice Address - Phone:858-552-1499
Practice Address - Fax:858-452-1517
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP10424CMedicare ID - Type Unspecified