Healthcare Provider Details

I. General information

NPI: 1083954325
Provider Name (Legal Business Name): DAVID M. LECHUGA, PH.D., A.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2013
Last Update Date: 02/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ORCHARD SUITE 103
LAKE FOREST CA
92630-8320
US

IV. Provider business mailing address

13 ORCHARD SUITE 103
LAKE FOREST CA
92630-8320
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-3358
  • Fax: 949-837-0274
Mailing address:
  • Phone: 949-837-3358
  • Fax: 949-837-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY10139
License Number StateCA

VIII. Authorized Official

Name: DAVID M LECHUGA
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 949-837-3358