Healthcare Provider Details

I. General information

NPI: 1134528573
Provider Name (Legal Business Name): DANIEL ANDERSON J.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MOTOR AVE
LOS ANGELES CA
90034-3710
US

IV. Provider business mailing address

3200 MOTOR AVE
LOS ANGELES CA
90034-3710
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-1223
  • Fax:
Mailing address:
  • Phone: 310-836-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29057
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2012482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: