Healthcare Provider Details

I. General information

NPI: 1750611232
Provider Name (Legal Business Name): JESSICA SUZANNE SCHACHTER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4018 CITY TERRACE DR
LOS ANGELES CA
90063-1242
US

IV. Provider business mailing address

385 IMPERIAL HWY
FULLERTON CA
92835
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-3219
  • Fax:
Mailing address:
  • Phone: 714-681-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY29398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: