MARK L ETTENHOFER (NPI# 1922480755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922480755 |
| Entity Type | Individual |
| Full Name | MARK L ETTENHOFER |
| Credential | PHD |
| Practice Address |
34800 Bob Wilson Dr San Diego CA 92134-1098 |
| Practice Telephone | 3016783321 |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2015-06-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 04643 | MD | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
04643 | MD | Behavioral Health & Social Service Providers |
| Street Address |
34800 BOB WILSON DR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92134-1098 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245235134 | Willie S Chao | Dentist | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2005-06-16 |
| 1023625571 | Samantha Savite | Student in an Organized Health Care Education/Training Program | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-09-29 |
| 1588270326 | Angelina Yvette Harris | Military Health Care Provider | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-09-17 |
| 1275149296 | Alexa Werner | Physical Therapist | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-09-16 |
| 1376157164 | Toure Marlow Hinton | Military Health Care Provider | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-08-31 |
| 1316550106 | John K Housinga | Military Health Care Provider | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-08-31 |
| 1073126249 | Alfredo Carrillo | Military Health Care Provider | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-08-27 |
| 1326651647 | Daniel Adan Denge | Registered Nurse | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-08-26 |
| 1275146664 | Zachariah Jacob Charles Boydsnee | Military Health Care Provider | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-08-26 |
| 1245843820 | Nikole Lanchares | Dentist | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2020-08-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477178457 | Joseph Hunter Sampson | Military Health Care Provider | 34101 Farenholt Ave #14, San Diego, CA 92134 | 2020-06-15 |
| 1508495201 | Benjamin Michael Taylor | Military Health Care Provider | Naval Medical Center San Diego Psychiatry Residency Pgm, 34800 Bob Wilson Drive, San Diego, CA 92134 | 2020-04-04 |
| 1255870333 | Dosh Page | Physician Assistant | Swmi Farenholt Avenue, Building 14, San Diego, CA 92134 | 2017-02-22 |
| 1417328063 | Noem Clay Gallego | Military Health Care Provider | 34101 Building 14, Farenholt Avenue, San Diego, CA 92134 | 2015-10-08 |
| 1972999183 | Justin Paul Lachney | Military Health Care Provider | 34101 Farenholt Avenue, San Diego, CA 92134 | 2015-04-14 |
| 1174963532 | Ryan Anders Crane | Otolaryngology | Department of Otolaryngology - Nmc San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 | 2013-07-01 |
| 1447591268 | Amy B. Cornell | Student in an Organized Health Care Education/Training Program | 34800 Bob Wilson Drive, San Diego, Ca, Apo, AA 92134 | 2013-03-04 |
| 1841562956 | Christopher Patrick Androski Jr. | Emergency Medical Technician, Basic | Naval Medical Center San Diego 38400 Bob Wilson Dr, San Diego, CA 92134 | 2012-02-04 |
| 1164717740 | Jason James Weiner | Internal Medicine | Dept of Internal Medicine, Division of Rheumatology, 34800 Bob Wilson Drive, San Diego, CA 92134 | 2011-06-13 |
| 1225320237 | Kimberly Ann Thompson | Student in an Organized Health Care Education/Training Program | Navy Medical Center San Diego Gme Department, 34800 Bob Wilson Dr., San Diego, CA 92134 | 2011-05-09 |
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| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265045975 | Well Psychology, Inc. | Clinical Neuropsychologist | 3525 Del Mar Heights Rd # 1881, San Diego, CA 92130-2199 | 2020-08-24 |
| 1437767399 | Ni Sun-suslow | Clinical Neuropsychologist | 220 Dickinson St # B, San Diego, CA 92103-2071 | 2020-07-16 |
| 1528414430 | Mitchel D Pelrman | Clinical Neuropsychologist | 2430 Palermo Dr, San Diego, CA 92106-1221 | 2016-05-10 |
| 1528468816 | Erin Almklov | Clinical Neuropsychologist | 11512 El Camino Real, 350, San Diego, CA 92130-2087 | 2014-08-25 |
| 1871930404 | Mili Parikh | Clinical Neuropsychologist | 5752 Oberlin Dr # 112, San Diego, CA 92121-1747 | 2013-05-22 |
| 1629329164 | Joanna Jacobus | Clinical Neuropsychologist | 3350 La Jolla Village Dr # Mc151b, San Diego, CA 92161-0002 | 2012-09-24 |
| 1619251790 | Barbara Jean Schrock | Clinical Neuropsychologist | 5989 Cozzens St, San Diego, CA 92122-3724 | 2011-10-06 |
| 1598099657 | Cheryl La Sasso | Clinical Neuropsychologist | 12526 High Bluff Dr Ste 300, San Diego, CA 92130-2067 | 2009-09-22 |
| 1295963288 | Delia Maria Silva | Clinical Neuropsychologist | 1901 1st Ave., Ste 245, San Diego, CA 92101 | 2009-06-29 |
| 1629264130 | Spencer Wetter | Clinical Neuropsychologist | 9648 Caminito Del Feliz, San Diego, CA 92121-1903 | 2007-09-18 |
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| 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.