Healthcare Provider Details

I. General information

NPI: 1083462477
Provider Name (Legal Business Name): RHONDA GORDON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N LAKE AVE STE 800
PASADENA CA
91101-1870
US

IV. Provider business mailing address

2212 HERITAGE WAY
FULLERTON CA
92833-1229
US

V. Phone/Fax

Practice location:
  • Phone: 800-314-7273
  • Fax:
Mailing address:
  • Phone: 310-617-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: