=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134335284
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUE ANNE MORRISON TONKINS PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 E KATELLA AVE STE D
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92867-5090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-343-1251
-----------------------------------------------------
Fax | 714-389-6119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2960 CHAMPION WAY APT 2108
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92782-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-508-5731
-----------------------------------------------------
Fax | 714-389-6119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 16004
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------