DR. BRENDA KAY WIEDERHOLD (NPI# 1134745474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134745474 |
| Entity Type | Individual |
| Full Name | DR. BRENDA KAY WIEDERHOLD |
| Credential | PH.D. |
| Practice Address |
Virtual Reality Medical Center 9834 Genesee Avenue, Suite 427 La Jolla CA 92037 |
| Mailing Address |
Virtual Reality Medical Center 6540 Lusk Boulevard, Suite C252 San Diego CA 92121 |
| Practice Telephone | 8586420267 |
| Mailing Telephone | 8586420267 |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY16840 | CA | Behavioral Health & Social Service Providers |
| Street Address |
VIRTUAL REALITY MEDICAL CENTER 9834 GENESEE AVENUE, SUITE 427 |
| City | LA JOLLA |
| State | CA |
| Zip Code | 92037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982221768 | Equip Health Medical, PC | Clinic/Center | 2674 Costebelle Drive, Unit A, La Jolla, CA 92037 | 2020-06-29 |
| 1316581598 | Kathleen M Blechertas | Physical Therapist | 9888 Genesee, Lj19, La Jolla, CA 92037 | 2019-10-31 |
| 1316592876 | Kevin Yanyan Li | Student in an Organized Health Care Education/Training Program | 9300 Campus Point Drive, Mc7400, La Jolla, CA 92037 | 2019-08-01 |
| 1407400542 | Juan J Salmeron | Dentist | Callejin Internacional 351 L2, Los Algodones, BAJA CALIFORNIA 92037 | 2019-07-26 |
| 1609428598 | Nicole Whitney Mark | Physician Assistant | 8103 Caminito Sonoma, La Jolla, CA 92037 | 2019-07-11 |
| 1700357936 | Cecelia Rose Greene/pendzich | Mastectomy Fitter | 7760 Fay Ave, Suite M., La Jolla, CA 92037 | 2018-12-16 |
| 1740765890 | Jeenal Ankit Gordhandas | Student in an Organized Health Care Education/Training Program | East Campus Office Building, Medical Center Dr, La Jolla, CA 92037 | 2018-09-25 |
| 1306325220 | Lisa Beth Perlov Marks | Marriage & Family Therapist | 7734 Hershel Avenue, Suite O, La Jolla, CA 92037 | 2018-08-10 |
| 1023596731 | Uc San Diego, Pathology Dept | Pathology | East Campus Office Building, Medical Center Dr, San Diego, CA 92037 | 2018-08-03 |
| 1891288197 | Maria Bernadette Facun | Nurse Practitioner | 10666 N. Torrey Pines Road, N203, La Jolla, CA 92037 | 2018-06-11 |
| Find all providers in zip 92037 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083122014 | Bernadette M Di Toro | Psychologist | 7440 Girard Ave Ste 1, La Jolla, CA 92037-5157 | 2018-01-11 |
| 1144770207 | Deisy C. Boscan Ph.d. Psychologist Professional Corporation | Psychologist | 7946 Ivanhoe Ave Ste 305, La Jolla, CA 92037-4518 | 2016-10-12 |
| 1023566940 | Deborah K Hopper | Psychologist | 8124 Caminito Sonoma, La Jolla, CA 92037-2923 | 2016-09-20 |
| 1750758595 | Katherine Bangen | Psychologist | 9500 Gilman Drive, Mail Code 151b, La Jolla, CA 92093-9151 | 2015-08-27 |
| 1659759355 | Lisa Kristine Jensen | Psychologist | 3252 Holiday Ct Ste 201, La Jolla, CA 92037-1808 | 2015-05-13 |
| 1376800771 | Lavinia Fiorentino | Psychologist | 3855 Health Sciences Dr # 658, Suite 3086, La Jolla, CA 92093-1503 | 2012-04-23 |
| 1942529409 | Dianna Quach | Psychologist | 9500 Gilman Dr Dept 304, La Jolla, CA 92093-0304 | 2010-05-24 |
| 1538391909 | Christina M Watson | Psychologist | 7825 Fay Ave Ste 200, La Jolla, CA 92037-4270 | 2009-08-18 |
| 1376771048 | Maryann Stieber | Psychologist | 1020 Prospect St., Ste. 415, La Jolla, CA 92037 | 2009-07-01 |
| 1780820415 | Suzanne Mathews | Psychologist | 7946 Ivanhoe Ave Ste 211, La Jolla, CA 92037-4517 | 2008-12-30 |
| Find all providers in LA JOLLA | ||||
Please comment or provide details below to improve the information on DR. BRENDA KAY WIEDERHOLD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.