Basic Information
| Provider Information | |||||||||
| NPI: | 1619147444 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | R. | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PRISON ROAD | ||||||||
| Address2: | CALIFORNIA STATE PRISON - SACRAMENTO | ||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956713000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162943175 | ||||||||
| FaxNumber: | 9162943122 | ||||||||
| Practice Location | |||||||||
| Address1: | CALIFORNIA STATE PRISON - SACRAMENTO | ||||||||
| Address2: | 100 PRISON ROAD | ||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956713000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162943175 | ||||||||
| FaxNumber: | 9162943122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2008 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY 17303 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.