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General NPI Number Information
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NPI Number | 1194467787
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Entity Type | Organization
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Legal Business Name | L & M CLINICAL AND FORENSIC PSYCHOLOGY
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1050 LAKES DR STE 225
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City | WEST COVINA
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State | CA
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Zip | 91790-2910
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Country | US
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Telephone | 562-231-6979
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2795
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City | DOWNEY
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State | CA
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Zip | 90242-1795
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL RUIZ
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Credential | PSY.D
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Telephone | 562-231-6979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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