Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY7320 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY7320 | CA |
N | 102L00000X | Psychologist | PSY7320 | CA |
N | 103T00000X | Psychologist | PSY7320 | CA |
N | 103G00000X | Clinical Psychologist | PSY7320 | CA |
N | 103TC0700X | Clinical Psychologist | PSY7320 | CA |
N | 103TH0100X | Health Service | PSY7320 | CA |
NPI | 1023002136 |
---|---|
Provider Name | Dr. Manuel David Tobias |
First Address | La Jolla, CA 92037-1808 |
Second Address | La Jolla, CA 92037-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 06/02/2018 |