Healthcare Provider Details

I. General information

NPI: 1134250194
Provider Name (Legal Business Name): LEO MATTHEW DUGGAN III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 E 7TH ST
LONG BEACH CA
90804-5311
US

IV. Provider business mailing address

4137 E 7TH ST
LONG BEACH CA
90804-5311
US

V. Phone/Fax

Practice location:
  • Phone: 562-433-7652
  • Fax: 562-433-8152
Mailing address:
  • Phone: 562-433-7652
  • Fax: 562-433-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: