Healthcare Provider Details

I. General information

NPI: 1215005608
Provider Name (Legal Business Name): EDWARD DUNBAR ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 N DOUGLAS ST
EL SEGUNDO CA
90245-2801
US

IV. Provider business mailing address

877 N DOUGLAS ST
EL SEGUNDO CA
90245-2801
US

V. Phone/Fax

Practice location:
  • Phone: 310-536-0211
  • Fax: 310-536-0215
Mailing address:
  • Phone: 310-536-0211
  • Fax: 310-536-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12304
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY12304
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY12304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: