=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174907810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANAHEIM HILLS PSYCHOLOGICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2015
-----------------------------------------------------
Last Update Date | 07/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 N RIVERVIEW DR STE. 209
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92808-1225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-769-9050
-----------------------------------------------------
Fax | 714-941-9199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 17635
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92817-7635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-769-9050
-----------------------------------------------------
Fax | 714-941-9199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ALEXANDRA J. ROGERS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 714-769-9050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY10192
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------