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General NPI Number Information
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NPI Number | 1033878210
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Entity Type | Individual
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Provider Name | NOAH MALUHIA LAU BRANSON PSYD
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Gender | Male
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 01/22/2022
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Provider Practice Location Address
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Address Line | 350 S LAKE AVE STE 284D
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City | PASADENA
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State | CA
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Zip | 91101-5074
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Country | US
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Telephone | 818-659-5903
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41153
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City | PASADENA
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State | CA
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Zip | 91114-8153
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Country | US
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Telephone | 626-808-6259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32992
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License Number State | CA
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