Provider Demographics
NPI:1770642134
Name:ANBAR, TOMER (PHD, CGP, CTC)
Entity Type:Individual
Prefix:DR
First Name:TOMER
Middle Name:
Last Name:ANBAR
Suffix:
Gender:M
Credentials:PHD, CGP, CTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4192 GRAYDON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2116
Mailing Address - Country:US
Mailing Address - Phone:858-405-8238
Mailing Address - Fax:858-228-1757
Practice Address - Street 1:8355 CLIFFRIDGE AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-2107
Practice Address - Country:US
Practice Address - Phone:858-405-8238
Practice Address - Fax:858-228-1757
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP15744103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103T00000X, 103TH0100X, 103TP0814X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15744Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST