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General NPI Number Information
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NPI Number | 1104143197
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Entity Type | Individual
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Provider Name | POONAM NINA BANERJEE PHD
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Gender | Female
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 20409 YORBA LINDA BLVD STE 129-K
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City | YORBA LINDA
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State | CA
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Zip | 92886-3042
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Country | US
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Telephone | 917-370-6350
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Fax | 949-208-6981
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Provider Business Mailing Address
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Address Line | 20409 YORBA LINDA BLVD STE 129-K
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City | YORBA LINDA
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State | CA
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Zip | 92886-3042
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Country | US
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Telephone | 917-370-6350
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Fax | 949-208-6981
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY24249
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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 | PSY 24249
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License Number State | CA
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