Healthcare Provider Details

I. General information

NPI: 1912177551
Provider Name (Legal Business Name): DAVID I. SITZER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 AVENUE I SUITE 204
REDONDO BEACH CA
90277-5608
US

IV. Provider business mailing address

225 AVENUE I SUITE 204
REDONDO BEACH CA
90277-5608
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-3288
  • Fax:
Mailing address:
  • Phone: 310-855-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY21769
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21769
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY21769
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21769
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY21769
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY21769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: