Healthcare Provider Details

I. General information

NPI: 1598960148
Provider Name (Legal Business Name): CINDY JOHN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MAIL STOP 53
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

129 REGAL
IRVINE CA
92620
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6675
  • Fax:
Mailing address:
  • Phone: 909-528-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: