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Organization
VIRTUAL REALITY MEDICAL CENTER
Active
Organization
VIRTUAL REALITY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D WIEDERHOLD M.D., PH.D., FACP (PRESIDENT)
(858) 642-0267
Entity
Organization
Contact information
Practice address
6540 LUSK BLVD STE C115, SAN DIEGO, CA 92121-2767
(858) 642-0267
Mailing address
6540 LUSK BLVD STE C115, SAN DIEGO, CA 92121-2767
(858) 642-0267
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY16840
CA
Other
Enumeration date
06/04/2015
Last updated
05/17/2016
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