Provider Demographics
NPI:1679686083
Name:WOLGIN, DAVID MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:WOLGIN
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 1:1111 E TAHQUITZ CANYON WAY STE 209
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-0102
Mailing Address - Country:US
Mailing Address - Phone:760-424-2266
Mailing Address - Fax:760-424-2266
Practice Address - Street 1:1111 E TAHQUITZ CANYON WAY STE 209
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0102
Practice Address - Country:US
Practice Address - Phone:760-424-2266
Practice Address - Fax:760-424-2266
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27046103TC0700X
MA7114103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA405446OtherTUFTS PROVIDER NUMBER
MAWO 5934OtherBC/BS PROVIDER NUMBER
MAWO W50538Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER