Provider Demographics
NPI:1619925583
Name:TAYER, WENDY G (PHD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:TAYER
Suffix:
Gender:F
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 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UCSD MEDICAL GROUP
Practice Address - Street 2:9300 CAMPUS POINT DRIVE, MC 7602
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-657-6878
Practice Address - Fax:858-657-6075
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY172010Medicaid
CACP17201Medicare ID - Type Unspecified
CAP37606Medicare UPIN