Healthcare Provider Details

I. General information

NPI: 1871804005
Provider Name (Legal Business Name): DUSTIN PLATTNER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 N ROSEMEAD BLVD STE 207
PASADENA CA
91107-3053
US

IV. Provider business mailing address

3579 E FOOTHILL BLVD # 710
PASADENA CA
91107-3119
US

V. Phone/Fax

Practice location:
  • Phone: 626-788-5853
  • Fax:
Mailing address:
  • Phone: 626-788-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-26516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: