Healthcare Provider Details

I. General information

NPI: 1982712386
Provider Name (Legal Business Name): DAVID M LECHUGA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ORCHARD ROAD SUITE 103
LAKE FOREST CA
92630-8321
US

IV. Provider business mailing address

13 ORCHARD ROAD SUITE 103
LAKE FOREST CA
92630-8321
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 TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY606
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY10139
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3274
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: