Healthcare Provider Details

I. General information

NPI: 1679706568
Provider Name (Legal Business Name): JONATHAN OMAR ARDITTI PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

11705 S ALAMEDA ST
LYNWOOD CA
90262-4023
US

V. Phone/Fax

Practice location:
  • Phone: 213-222-3797
  • Fax:
Mailing address:
  • Phone: 949-385-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: