Healthcare Provider Details

I. General information

NPI: 1306961644
Provider Name (Legal Business Name): ANITA H HAMILTON PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 OLD RANCH PKWY STE 328
SEAL BEACH CA
90740-2751
US

IV. Provider business mailing address

3020 OLD RANCH PKWY STE 328
SEAL BEACH CA
90740-2751
US

V. Phone/Fax

Practice location:
  • Phone: 562-477-5674
  • Fax:
Mailing address:
  • Phone: 562-477-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY21241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: