Healthcare Provider Details

I. General information

NPI: 1003862137
Provider Name (Legal Business Name): LANA DELSHADI ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 CHERRY ST STE 211
LOS ALAMITOS CA
90720-5402
US

IV. Provider business mailing address

10861 CHERRY ST STE 211
LOS ALAMITOS CA
90720-5402
US

V. Phone/Fax

Practice location:
  • Phone: 714-229-0094
  • Fax: 714-229-0180
Mailing address:
  • Phone: 714-229-0094
  • Fax: 714-229-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY16895
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: