VIRTUAL REALITY MEDICAL CENTER


Address: 6540 Lusk Blvd Ste C115, San Diego, CA 92121-2767
Phone: 8586420267

VIRTUAL REALITY MEDICAL CENTER (NPI# 1396125456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1396125456
Entity Type Organization
Organization Name VIRTUAL REALITY MEDICAL CENTER
Practice Address 6540 Lusk Blvd Ste C115
San Diego
CA 92121-2767
Practice Telephone 8586420267
Mailing Telephone 8586420267
Enumeration Date 2015-06-04
Last Update Date 2016-05-17
Authorized Official Name DR. MARK D WIEDERHOLD (PRESIDENT)
Authorized Official Telephone 8586420267
Authorized Official Credential M.D., PH.D., FAC
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TC0700X Psychologist
Specialization: Clinical
PSY16840 CA Behavioral Health & Social Service Providers

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1659453769 Virtual Reality Medical Center Clinic/Center 6160 Cornerstone Court East, Ste 155, San Diego, CA 92121 2006-10-19

Other Data Sources

Entity Type Entity Name Entity Address
System for Award Management (SAM) Entities VIRTUAL REALITY MEDICAL CENTER, THE 6540 Lusk Blvd Ste C115, San Diego, CA 92121-2767

Office Location

Street Address 6540 LUSK BLVD STE C115
City SAN DIEGO
State CA
Zip Code 92121-2767

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Taxonomy Information

Taxonomy Code 103TC0700X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical

Taxonomy Definition

Definition to come...

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Competitor

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City SAN DIEGO
Zip Code 92121

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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