MEDICARE: DR. ELIZABETH RAY ANDERS PSY PHD

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	103T00000X	Psychologist	PSY 14697	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY 14697	OTHER	CA	CALIFORNIA BOARD OF PSYCHOLOGY

General Provider Information

NPI Number	:	1922419050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH RAY ANDERS PSY PHD

Provider Business Mailing Address
First Line	:	5944 S CHARITON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1506
Country	:	US
Telephone Number	:	213-595-2319
Fax Number	:

Provider Business Practice Location Address
First Line	:	5944 S CHARITON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1506
Country	:	US
Telephone Number	:	213-595-2319
Fax Number	:

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

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	05/12/2014

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