Provider Demographics
NPI:1265499412
Name:FELTMAN, RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FELTMAN
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:PO BOX 16374
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92176-6374
Mailing Address - Country:US
Mailing Address - Phone:858-576-3855
Mailing Address - Fax:858-576-3855
Practice Address - Street 1:2423 CAMINO DEL RIO S
Practice Address - Street 2:STE 207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3735
Practice Address - Country:US
Practice Address - Phone:858-576-3855
Practice Address - Fax:858-576-3855
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY097540OtherMEDI-CAL
CAPSY097540OtherMEDI-CAL