Provider Demographics
NPI:1720182850
Name:WEBER, ROBERT DONALD KREUTZ JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DONALD KREUTZ
Last Name:WEBER
Suffix:JR
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:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93443-1041
Mailing Address - Country:US
Mailing Address - Phone:805-541-1964
Mailing Address - Fax:805-541-1964
Practice Address - Street 1:1329 CHORRO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:95401
Practice Address - Country:US
Practice Address - Phone:805-541-1964
Practice Address - Fax:805-541-1964
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPS0094060Medicaid
CP9406Medicare ID - Type Unspecified