Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 120499 | CA |
Y | 103T00000X | Psychologist | 120499 | CA |
NPI | 1013686633 |
---|---|
Provider Name | Vittorio Roberti |
First Address | San Diego, CA 92109-2335 |
Second Address | San Diego, CA 92110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2021 |
Last Update Date | 08/09/2021 |