Provider Demographics
NPI:1417080649
Name:KLEBEL, WOLFGANG ANGELUS (PHD)
Entity Type:Individual
Prefix:
First Name:WOLFGANG
Middle Name:ANGELUS
Last Name:KLEBEL
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 1:1550 CHESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-3726
Mailing Address - Country:US
Mailing Address - Phone:951-928-6326
Mailing Address - Fax:
Practice Address - Street 1:623 E LATHAM AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4342
Practice Address - Country:US
Practice Address - Phone:951-928-6326
Practice Address - Fax:951-344-8353
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-BEHSMedicaid