Healthcare Provider Details

I. General information

NPI: 1275168536
Provider Name (Legal Business Name): PAULA LETICIA CEDILLO PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 E COMPTON BLVD
COMPTON CA
90221-3307
US

IV. Provider business mailing address

2785 PACIFIC COAST HWY STE E
TORRANCE CA
90505-7066
US

V. Phone/Fax

Practice location:
  • Phone: 310-637-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number31658
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number31658
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number31658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: