Healthcare Provider Details

I. General information

NPI: 1487960779
Provider Name (Legal Business Name): SHARONNE HERBERT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE DEPARTMENT OF PEDIATRIC PSYCHOLOGY
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1201 W LA VETA AVE DEPARTMENT OF PEDIATRIC PSYCHOLOGY
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8481
  • Fax: 714-509-8756
Mailing address:
  • Phone: 714-509-8481
  • Fax: 714-509-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY27074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: