Virtual Reality Medical Center

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY16840 Issued in CA

Legal business name

VIRTUAL REALITY MEDICAL CENTER

Practice address

6540 Lusk Blvd Ste C115
San Diego, CA 92121-2767

Phone

(858) 642-0267

NPI assigned

Jun 4, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark D Wiederhold, M.D., PH.D., FACP

Title

President

Phone

(858) 642-0267

Specialties & licenses 1

Addresses

Tax ID family

Virtual Reality Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Virtual Reality Medical Center

  • Clinic/Center
  • San Diego, CA
  • NPI 1659453769
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463443200000",
    "number": "1396125456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6540 LUSK BLVD STE C115",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212767",
            "telephone_number": "858-642-0267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6540 LUSK BLVD STE C115",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212767",
            "telephone_number": "858-642-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRTUAL REALITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2016-05-17",
        "status": "A",
        "authorized_official_last_name": "WIEDERHOLD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-642-0267",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D., FACP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Rose Virgilio, M.D.
• Virgnia Padua Mattson D.M.D.
• Pawendeep Virk
• Pritbir S Virk, D.O.
• Eileen Caoile Virrey, FNP-BC,APRN,BSN,RN
• Virtual Reality Medical Center
• Virtual Somnologist, Inc
• Virtual Speech Therapy LLC
• Virtuosity Health & Wellness PC
• Carrie Visalli, CD(DONA)

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.