=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275835761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LESTER A MINDUS PHD A PSYCHOLOGY CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2010
-----------------------------------------------------
Last Update Date | 12/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17215 STUDEBAKER ROAD SUITE 110
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-2521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-860-2210
-----------------------------------------------------
Fax | 526-860-1154
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17215 STUDEBAKER ROAD SUITE 110
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-2521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-860-2210
-----------------------------------------------------
Fax | 526-860-1154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/OWNER
-----------------------------------------------------
Name | LESTER A MINDUS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 562-860-2210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | P3Y5564
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------