Healthcare Provider Details

I. General information

NPI: 1205382777
Provider Name (Legal Business Name): CONRAD DANIEL SPEZZACATENA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 W OLYMPIC BLVD STE 1270E
LOS ANGELES CA
90064-5053
US

IV. Provider business mailing address

11835 W OLYMPIC BLVD STE 1270E
LOS ANGELES CA
90064-5053
US

V. Phone/Fax

Practice location:
  • Phone: 623-377-7410
  • Fax:
Mailing address:
  • Phone: 623-377-7410
  • Fax: 866-798-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4763
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4763
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: