Provider Demographics
NPI:1548306269
Name:HESSLER, JOHN LAWRENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:HESSLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5611
Mailing Address - Country:US
Mailing Address - Phone:619-298-7488
Mailing Address - Fax:619-298-7488
Practice Address - Street 1:815 3RD AVE
Practice Address - Street 2:107
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1307
Practice Address - Country:US
Practice Address - Phone:619-426-1555
Practice Address - Fax:619-426-1906
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9643103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPW0096430Medicaid
CACP9643Medicare ID - Type UnspecifiedCMS