Healthcare Provider Details

I. General information

NPI: 1407340615
Provider Name (Legal Business Name): HEMALI LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E SANTA ANA CANYON RD STE 261
ANAHEIM CA
92807-3121
US

IV. Provider business mailing address

5456 E WILLOWICK CIR
ANAHEIM CA
92807-4642
US

V. Phone/Fax

Practice location:
  • Phone: 714-280-8205
  • Fax:
Mailing address:
  • Phone: 714-280-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: