Provider Demographics
NPI:1629507728
Name:FREDRIC A. SELDIN, PH.D., PC
Entity Type:Organization
Organization Name:FREDRIC A. SELDIN, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:SELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-813-5923
Mailing Address - Street 1:7840 MISSION CENTER CT STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1320
Mailing Address - Country:US
Mailing Address - Phone:619-813-5923
Mailing Address - Fax:619-618-1795
Practice Address - Street 1:7840 MISSION CENTER CT STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1320
Practice Address - Country:US
Practice Address - Phone:619-813-5923
Practice Address - Fax:619-618-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7890440Medicaid