Healthcare Provider Details

I. General information

NPI: 1508866781
Provider Name (Legal Business Name): DAVID V DALEO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W OLYMPIC BLVD SUITE 108
BEVERLY HILLS CA
90212-4687
US

IV. Provider business mailing address

9200 W OLYMPIC BLVD SUITE 108
BEVERLY HILLS CA
90212-4687
US

V. Phone/Fax

Practice location:
  • Phone: 310-956-2345
  • Fax: 310-728-6372
Mailing address:
  • Phone: 310-956-2345
  • Fax: 310-728-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 18066
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 18066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: