Healthcare Provider Details

I. General information

NPI: 1013147461
Provider Name (Legal Business Name): SHANNON ELIZABETH LA CAVA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UCLA MEDICAL PLZ STE 502
LOS ANGELES CA
90095-6934
US

IV. Provider business mailing address

200 UCLA MEDICAL PLZ STE 502
LOS ANGELES CA
90095-6934
US

V. Phone/Fax

Practice location:
  • Phone: 310-562-6293
  • Fax:
Mailing address:
  • Phone: 310-562-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY27456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: