MEDICARE: DR. PATRICE K. SPINNER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 20628	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY 20628	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1437355021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICE K. SPINNER PH.D.

Provider Business Mailing Address
First Line	:	1554 S SEPULVEDA BLVD
Second Line	:	#207
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3377
Country	:	US
Telephone Number	:	310-281-1913
Fax Number	:	310-474-6333

Provider Business Practice Location Address
First Line	:	1554 S SEPULVEDA BLVD
Second Line	:	#207
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3377
Country	:	US
Telephone Number	:	310-281-1913
Fax Number	:	310-474-6333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	01/26/2012

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