Kathy Ann Vandenburgh, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY14408 Issued in CA

Practice address

6160 Cornerstone CT E
Suite 155
San Diego, CA 92121-3720

Phone

(858) 642-0267

NPI assigned

Jan 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Virtual Reality Medical Center

  • Clinic/Center
  • San Diego, CA
  • NPI 1659453769
  NPD (past)

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760537328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10755 SCRIPPS POWAY PKWY STE F",
            "address_2": "PMB # 137",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313924",
            "telephone_number": "858-486-7345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 CORNERSTONE CT E",
            "address_2": "SUITE 155",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213720",
            "telephone_number": "858-642-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBURGH",
        "first_name": "KATHY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY14408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Leslie Vande Vegte, P.T.
• Russell Allen Vande Vegte, PT
• Jeffrey Vandemark, PHARMD
• Kelsey Jordan Vanden Heuvel, MS, RDN
• Michael James Vandenbroek
• Kelly L Vandenheuvel, MD
• Brandon Paul Vander Hulst
• Marissa Rose Vander Missen
• Bryan Matthew Vander Schuur, M.D.
• Kathryn Vander Voort Wilson

• 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 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.

Verify at the official NPI Registry.