Healthcare Provider Details

I. General information

NPI: 1396397931
Provider Name (Legal Business Name): ROSALEEN KAUR DHALIWAL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 BLOOMFIELD AVE
NORWALK CA
90650-2015
US

IV. Provider business mailing address

1125 N FAIRFAX AVE UNIT 461876
WEST HOLLYWOOD CA
90046-8633
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax:
Mailing address:
  • Phone: 562-474-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: