Healthcare Provider Details

I. General information

NPI: 1982945689
Provider Name (Legal Business Name): LEMON HEIGHTS HOLDINGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 STUDEBAKER ROAD SUITE 110
CERRITOS CA
90703-2521
US

IV. Provider business mailing address

PO BOX 2089
ARTESIA CA
90702-2089
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-2210
  • Fax: 562-860-1154
Mailing address:
  • Phone: 562-860-2210
  • Fax: 714-940-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10129
License Number StateCA

VIII. Authorized Official

Name: ROBERT NILS JOHANSEN
Title or Position: OWNER-OFFICER
Credential: PH.D.
Phone: 562-860-2210