NPIMap

Organization Active NPI

Tracy Wutzke, Psy.D

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1750827499
Registry record updated Nov 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY17239 Issued in CA
Legal business name
TRACY WUTZKE, PSY.D
Practice address
9888 Carroll Centre Rd Ste 216
San Diego, CA 92126-4515
Phone
(858) 413-7557
Fax
(858) 217-5285
NPI assigned
Jan 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2021

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

Authorized official

Name
Dr. Tracy Wutzke, PSY.DNPI 1841415122
Title
Clinical Psychologist
Phone
(858) 413-7557

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PSY17239 CA Primary
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X 52458 CA

Addresses

Primary practice location

9888 Carroll Centre Rd Ste 216
San Diego, CA 92126-4515

Mailing address

9888 Carroll Centre Rd Ste 216
San Diego, CA 92126-4515
Phone (858) 413-7557

Other identifiers 4

IdentifierTypeStateIssuer
100058167001OtherCABLUE SHIELD OF CALIFORNIA
240986OtherCAMHN
134599523187OtherCAHUMANA
0009236145OtherCAAETNA

Other names 2

  • Dr. Tracy Wutzke Other name
  • Wutzke, Tracy Other name

National Provider Directory

National Provider Directory

Locations

9888 Carroll Centre Rd
Ste 216
San Diego, CA 92126
Phone (619) 543-1222

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636848000000",
    "number": "1750827499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9888 CARROLL CENTRE RD STE 216",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264515",
            "telephone_number": "858-413-7557",
            "fax_number": "858-217-5285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 CARROLL CENTRE RD STE 216",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264515",
            "telephone_number": "858-413-7557",
            "fax_number": "858-217-5285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY WUTZKE, PSY.D",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-18",
        "last_updated": "2021-11-14",
        "certification_date": "2021-11-14",
        "status": "A",
        "authorized_official_last_name": "WUTZKE",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "858-413-7557",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17239",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "52458",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "100058167001",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "240986",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "134599523187",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0009236145",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Tracy Wutzke",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Wutzke, Tracy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2021; 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.