Active NPI
Burl Wagenheim, PH.D.
- Psychologist
- Downey, CA
National Provider Identifier
1174652440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 16594
- Practice address
- 7601 Imperial Hwy
HB 226
Downey, CA 90242-3456 - Phone
- (562) 401-6320
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 16594 | CA | Primary |
Addresses
Primary practice location
7601 Imperial Hwy
HB 226
Downey, CA 90242-3456
Mailing address
PO Box 3335
Seal Beach, CA 90740-2335
Phone (562) 401-6329
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 16594 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174652440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3335",
"city": "SEAL BEACH",
"state": "CA",
"postal_code": "907402335",
"telephone_number": "562-401-6329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7601 IMPERIAL HWY",
"address_2": "HB 226",
"city": "DOWNEY",
"state": "CA",
"postal_code": "902423456",
"telephone_number": "562-401-6320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGENHEIM",
"first_name": "BURL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 16594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Downey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.