Healthcare Provider Details

I. General information

NPI: 1518181734
Provider Name (Legal Business Name): DONALD STEPHEN BOSCH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S OAKLAND AVE 211
PASADENA CA
91101-2043
US

IV. Provider business mailing address

2937 SANTA ROSA AVE
ALTADENA CA
91001-1641
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-2975
  • Fax:
Mailing address:
  • Phone: 626-798-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: