Healthcare Provider Details

I. General information

NPI: 1720377559
Provider Name (Legal Business Name): BABA SINGH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9985 SIERRA AVE MOB 2-6TH FLR
FONTANA CA
92335-6720
US

IV. Provider business mailing address

PO BOX 6577
ALTADENA CA
91003-6577
US

V. Phone/Fax

Practice location:
  • Phone: 626-644-7930
  • Fax: 626-765-9647
Mailing address:
  • Phone: 626-644-7930
  • Fax: 626-765-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25299
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY25299
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY25299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: