Provider Demographics
NPI:1659305613
Name:MICHAEL R. REIDER, PH.D., APC
Entity Type:Organization
Organization Name:MICHAEL R. REIDER, PH.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:REIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:888-293-3182
Mailing Address - Street 1:9750 MIRAMAR ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4562
Mailing Address - Country:US
Mailing Address - Phone:888-293-3182
Mailing Address - Fax:888-293-3182
Practice Address - Street 1:9750 MIRAMAR ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4562
Practice Address - Country:US
Practice Address - Phone:888-293-3182
Practice Address - Fax:888-293-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13784103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY137840OtherMEDI-CAL
CAPSY137840OtherMEDI-CAL