Healthcare Provider Details

I. General information

NPI: 1548312150
Provider Name (Legal Business Name): DAVID LEE ANTION PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 S MARENGO AVE STE 102
PASADENA CA
91106-4737
US

IV. Provider business mailing address

745 S MARENGO AVE STE 102
PASADENA CA
91106-4737
US

V. Phone/Fax

Practice location:
  • Phone: 562-803-6545
  • Fax: 626-792-8028
Mailing address:
  • Phone: 562-803-6545
  • Fax: 626-792-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 9037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: