Healthcare Provider Details

I. General information

NPI: 1073655064
Provider Name (Legal Business Name): ANDREW C DEAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 S ORANGE DR
LOS ANGELES CA
90019-5314
US

IV. Provider business mailing address

1654 S ORANGE DR
LOS ANGELES CA
90019-5314
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5839
  • Fax: 310-825-0812
Mailing address:
  • Phone: 310-825-5839
  • Fax: 310-825-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21280
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY21280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: