Healthcare Provider Details

I. General information

NPI: 1003075235
Provider Name (Legal Business Name): DESIREE DELAGARZA PURCELL DOCTORATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY # 996
LAGUNA BEACH CA
92651-3681
US

IV. Provider business mailing address

1968 S COAST HWY # 996
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 949-370-9442
  • Fax: 361-353-4408
Mailing address:
  • Phone: 949-370-9442
  • Fax: 949-248-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY19575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY19575
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: