DR. BRENDA KAY WIEDERHOLD PH.D.
NPI 1134745474
Psychologist - Clinical in La Jolla, CA

Q: What is Brenda Wiederhold's NPI number?

The NPI number for Brenda Wiederhold is 1134745474. It was assigned to this individual provider in the NPPES registry on June 23, 2020.

Q: What is Brenda Wiederhold's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Brenda Wiederhold enrolled in Medicare?

No. Brenda Wiederhold has opted out of Medicare through December 1, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Brenda Wiederhold was last updated on June 23, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 23, 2020Opted out of Medicare · through Dec 1, 2026

VIRTUAL REALITY MEDICAL CENTER, 9834 GENESEE AVENUE, SUITE 427, LA JOLLA, CA 92037(858) 642-0267 Get Directions Write a Review

NPPES record last updated: June 23, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Brenda Kay Wiederhold Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BRENDA KAY WIEDERHOLD PH.D. (NPI 1134745474) is an individual clinical provider in La Jolla, California, licensed in California (PSY16840) and active in the NPI registry since June 2020. She has opted out of Medicare through December 1, 2026.

NPPES Registry Identity

NPI1134745474

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. BRENDA KAY WIEDERHOLDCredential: PH.D.

Location AddressVIRTUAL REALITY MEDICAL CENTER, 9834 GENESEE AVENUE, SUITE 427La Jolla, CA 92037

Mailing AddressVirtual Reality Medical Center, 6540 Lusk Boulevard, Suite C252San Diego, CA 92121 · (858) 642-0267

Phone(858) 642-0267

Sole ProprietorYes

Enumeration DateJune 23, 2020

NPPES CertifiedJune 23, 2020

✔ NPI 1134745474 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in CA · PSY16840

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

VIRTUAL REALITY MEDICAL CENTER, La Jolla, CA 92037

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Brenda Kay Wiederhold Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 1, 2020 through December 1, 2026.

Opt-Out Effective DateDecember 1, 2020

Opt-Out In Effect ThroughDecember 1, 2026Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brenda Wiederhold's NPI number?

The NPI number for Brenda Wiederhold is 1134745474. It was assigned to this individual provider in the NPPES registry on June 23, 2020.

Where is Brenda Wiederhold located?

Brenda Wiederhold practices at Virtual Reality Medical Center 9834 Genesee Avenue, Suite 427, La Jolla, CA 92037. The listed phone number is (858) 642-0267.

What is Brenda Wiederhold's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Brenda Wiederhold enrolled in Medicare?

No. Brenda Wiederhold has opted out of Medicare through December 1, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Brenda Wiederhold was last updated on June 23, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.