Healthcare Provider Details

I. General information

NPI: 1346562006
Provider Name (Legal Business Name): CRISTALLE Y. SESE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W 7TH ST STE 650
LOS ANGELES CA
90017-2577
US

IV. Provider business mailing address

1055 W 7TH ST STE. 650
LOS ANGELES CA
90017-2577
US

V. Phone/Fax

Practice location:
  • Phone: 323-863-5830
  • Fax:
Mailing address:
  • Phone: 323-863-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23296
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: