Provider Demographics
NPI:1992832109
Name:STANDAL, PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:STANDAL
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 1:4452 PARK BLVD
Mailing Address - Street 2:212
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4051
Mailing Address - Country:US
Mailing Address - Phone:858-775-2501
Mailing Address - Fax:619-684-5459
Practice Address - Street 1:4452 PARK BLVD
Practice Address - Street 2:212
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4051
Practice Address - Country:US
Practice Address - Phone:858-775-2501
Practice Address - Fax:619-684-5459
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSTAN-WCP21606AMedicare PIN