MEDICARE: DR. BARBARA ANNE AMMON 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	PSY11667	CA

General Provider Information

NPI Number	:	1588749915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA ANNE AMMON PH.D.

Provider Business Mailing Address
First Line	:	750 N DIAMOND BAR BLVD
Second Line	:	SUITE 204
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1023
Country	:	US
Telephone Number	:	909-396-7715
Fax Number	:	909-396-7701

Provider Business Practice Location Address
First Line	:	750 N DIAMOND BAR BLVD
Second Line	:	SUITE 204
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1023
Country	:	US
Telephone Number	:	909-396-7715
Fax Number	:	909-396-7701

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	09/23/2009

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