Healthcare Provider Details

I. General information

NPI: 1740973791
Provider Name (Legal Business Name): PSYCHOLOGY TASK FORCE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3928 COLEMAN AVE
SAN DIEGO CA
92154
US

IV. Provider business mailing address

136 N CHESTER AVE
PASADENA CA
91106-1805
US

V. Phone/Fax

Practice location:
  • Phone: 619-754-1928
  • Fax:
Mailing address:
  • Phone: 619-754-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD DE ANDA
Title or Position: CEO & PSYCHOLOGIST
Credential: PSYD
Phone: 619-754-1928