Healthcare Provider Details

I. General information

NPI: 1750312492
Provider Name (Legal Business Name): KAREN ELIZABETH DYMOND PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 S HARBOR BLVD STE 14
LA HABRA CA
90631-7570
US

IV. Provider business mailing address

1480 S HARBOR BLVD STE 14
LA HABRA CA
90631-7570
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-8782
  • Fax: 714-447-9386
Mailing address:
  • Phone: 714-447-8782
  • Fax: 714-447-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 16996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: