Healthcare Provider Details

I. General information

NPI: 1255666814
Provider Name (Legal Business Name): VERONICA PORCHE-ANDERSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VERONICA PORCHE PSY. D.

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 800E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST SUITE 920E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-601-0702
  • Fax:
Mailing address:
  • Phone: 310-601-0702
  • Fax: 310-659-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY22912
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22912
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY22912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: