Provider Demographics
NPI:1023002136
Name:TOBIAS, MANUEL DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:DAVID
Last Name:TOBIAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 HOLIDAY CT
Mailing Address - Street 2:STE 227
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1808
Mailing Address - Country:US
Mailing Address - Phone:858-362-8779
Mailing Address - Fax:858-455-5556
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:STE 227
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1808
Practice Address - Country:US
Practice Address - Phone:858-362-8779
Practice Address - Fax:858-455-5556
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7320103TC0700X, 103TH0100X, 103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMDCP7320Medicare ID - Type Unspecified