Most Relevant Information
Provider Data
| NPI Number: | 1003373713 |
| Provider Name: | ROBERT WILLIAM BLACK LPPC 17770 |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 17770 |
Most Important Dates
| Enumeration Date: | 02/28/2019 |
| Last Updated: | 11/06/2024 |
Provider Practice Location
4391 ELM ST
SAN DIEGO
CA
921055221
Practice Location Phone/Fax
| Phone: | 6198405386 |
| Fax: |
Provider Mailing Location
PO BOX 5070
SAN DIEGO
CA
921655070
Provider Mailing Phone/Fax
| Phone: | 6198405386 |
| Fax: |