Healthcare Provider Details

I. General information

NPI: 1316474026
Provider Name (Legal Business Name): DEVIN E KOWALCZYK PHD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WILSHIRE BLVD STE 1410
LOS ANGELES CA
90048-5815
US

IV. Provider business mailing address

6200 WILSHIRE BLVD STE 1410
LOS ANGELES CA
90048-5815
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number28887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number28887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: