Provider Demographics
NPI:1225360613
Name:MATTHEW J WELTSCH PSYCHOLOGIST
Entity Type:Organization
Organization Name:MATTHEW J WELTSCH PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:WELTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-218-9032
Mailing Address - Street 1:502 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3983
Mailing Address - Country:US
Mailing Address - Phone:619-218-9032
Mailing Address - Fax:760-743-6711
Practice Address - Street 1:502 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3983
Practice Address - Country:US
Practice Address - Phone:619-218-9032
Practice Address - Fax:760-743-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20348103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8435538Medicaid
CA8435538Medicaid