Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 30854 | CA |
Y | 103TC0700X | Clinical Psychologist | 30854 | CA |
N | 103TR0400X | Rehabilitation Psychologist | 30854 | CA |
NPI | 1285280073 |
---|---|
Provider Name | Daniel Koehler |
First Address | Los Altos, CA 94022-2360 |
Second Address | San Mateo, CA 94402-2717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2019 |
Last Update Date | 16/08/2019 |