Healthcare Provider Details

I. General information

NPI: 1962109223
Provider Name (Legal Business Name): ADAM ZACHARY CHESTER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 VIA DE LA PAZ STE E
PACIFIC PALISADES CA
90272-5223
US

IV. Provider business mailing address

20475 VIA TORRALBA
YORBA LINDA CA
92887-3218
US

V. Phone/Fax

Practice location:
  • Phone: 310-507-0631
  • Fax:
Mailing address:
  • Phone: 714-394-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number34017
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number34017
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number34017
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number34017
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number34017
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34017
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number34017
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number34017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: