Healthcare Provider Details

I. General information

NPI: 1275903205
Provider Name (Legal Business Name): OREN R. BOXER, PH.D., A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD MEZZANINE
PASADENA CA
91101-2039
US

IV. Provider business mailing address

595 E COLORADO BLVD MEZZANINE
PASADENA CA
91101-2039
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-4482
  • Fax:
Mailing address:
  • Phone: 626-765-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY24357
License Number StateCA

VIII. Authorized Official

Name: DR. OREN RONALD BOXER
Title or Position: PRESIDENT
Credential: PH.D
Phone: 626-765-4482