Provider Demographics
NPI:1700059128
Name:WAISMAN, PAULA ANDREA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ANDREA
Last Name:WAISMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 GOLDFINCH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2926
Mailing Address - Country:US
Mailing Address - Phone:619-615-8240
Mailing Address - Fax:
Practice Address - Street 1:3921 GOLDFINCH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2926
Practice Address - Country:US
Practice Address - Phone:619-615-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical