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General NPI Number Information
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NPI Number | 1093156630
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGYCA
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 9663 SANTA MONICA BLVD # 1058
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4303
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Country | US
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Telephone | 424-245-5524
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Fax |
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Provider Business Mailing Address
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Address Line | 9663 SANTA MONICA BLVD # 1058
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4303
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Country | US
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Telephone | 424-245-5524
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | DR. ALEXANDREA PARK
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Credential | PSY.D.
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Telephone | 424-245-5524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 25773
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 25773
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License Number State | CA
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