Provider Demographics
NPI:1679596282
Name:MAURER, WENDI (PHD)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:MAURER
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8813 VILLA LA JOLLA DR
Mailing Address - Street 2:STE 2002
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1927
Mailing Address - Country:US
Mailing Address - Phone:619-491-3459
Mailing Address - Fax:858-453-8634
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:SUITE 220
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:619-491-3459
Practice Address - Fax:858-453-8634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 12694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY126940Medicaid
CAPSY126940Medicaid