Provider Demographics
NPI:1528414430
Name:PELRMAN, MITCHEL D (PHD)
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:D
Last Name:PELRMAN
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 1:2430 PALERMO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1221
Mailing Address - Country:US
Mailing Address - Phone:619-255-5566
Mailing Address - Fax:
Practice Address - Street 1:2430 PALERMO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-1221
Practice Address - Country:US
Practice Address - Phone:619-255-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-10698103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist