Healthcare Provider Details

I. General information

NPI: 1366519787
Provider Name (Legal Business Name): NORMA LETICIA CANO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E. 20TH ST.
LONG BEACH CA
90806
US

IV. Provider business mailing address

240 E. 20TH ST.
LONG BEACH CA
90806
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-9271
  • Fax:
Mailing address:
  • Phone: 562-599-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: