Provider Demographics
NPI:1457454027
Name:BOHLINE, DAVID STEELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEELE
Last Name:BOHLINE
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 1:334 VIA VERA CRUZ
Mailing Address - Street 2:STE 207
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2641
Mailing Address - Country:US
Mailing Address - Phone:760-471-4900
Mailing Address - Fax:760-471-1930
Practice Address - Street 1:334 VIA VERA CRUZ
Practice Address - Street 2:STE 207
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2641
Practice Address - Country:US
Practice Address - Phone:760-471-4900
Practice Address - Fax:760-471-1930
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11688103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY116880Medicaid
R15658Medicare UPIN
CAPSY116880Medicaid