Healthcare Provider Details

I. General information

NPI: 1700145893
Provider Name (Legal Business Name): JOAN R DAVID, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 WARNER AVE., STE. 250-05
FOUNTAIN VALLEY CA
92708-2500
US

IV. Provider business mailing address

9550 WARNER AVE., STE. 250-05
FOUNTAIN VALLEY CA
92708-2500
US

V. Phone/Fax

Practice location:
  • Phone: 714-593-2355
  • Fax: 714-593-2399
Mailing address:
  • Phone: 714-593-2355
  • Fax: 714-593-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 22928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 22928
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 22928
License Number StateCA

VIII. Authorized Official

Name: JOAN R. DAVID
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 714-593-2355