Provider Demographics
NPI:1417027483
Name:NETTER, ROBERTO (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:NETTER
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 13034
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92039-3034
Mailing Address - Country:US
Mailing Address - Phone:858-552-8911
Mailing Address - Fax:858-793-5492
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:STE. 100
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:858-552-8911
Practice Address - Fax:858-793-5492
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11951103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0200X, 103TH0100X, 103T00000X, 103TP2701X
CAPSY1951103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY11951Medicaid
CAPSY11951Medicaid