Healthcare Provider Details

I. General information

NPI: 1083754089
Provider Name (Legal Business Name): ALAN D. PRICE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30423 CANWOOD ST STE 138
AGOURA HILLS CA
91301-4315
US

IV. Provider business mailing address

3533 N OXNARD BLVD
OXNARD CA
93036-5480
US

V. Phone/Fax

Practice location:
  • Phone: 818-707-7366
  • Fax:
Mailing address:
  • Phone: 808-351-1639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28367
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 454
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: