Healthcare Provider Details

I. General information

NPI: 1376520130
Provider Name (Legal Business Name): DAVID C. ANDERSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E COOLEY DR SUITE 100
COLTON CA
92324-3981
US

IV. Provider business mailing address

1420 E COOLEY DR SUITE 100
COLTON CA
92324-3981
US

V. Phone/Fax

Practice location:
  • Phone: 909-499-5625
  • Fax: 909-794-2113
Mailing address:
  • Phone: 909-499-5625
  • Fax: 909-794-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 6215
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 6215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: