Basic Information
| Provider Information | |||||||||
| NPI: | 1629094800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANZEKAUFER | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4832 CORONADO AVE APT 2 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921073336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585313338 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4550 KEARNY VILLA RD STE 116 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY 20862 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.