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General NPI Number Information
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NPI Number | 1386772663
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Entity Type | Individual
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Provider Name | ERIN LEIGH DORNAN-LIUZZO PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 3151 AIRWAY AVE STE A2
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City | COSTA MESA
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State | CA
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Zip | 92626-4620
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Country | US
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Telephone | 949-345-1186
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Fax |
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Provider Business Mailing Address
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Address Line | 18627 BROOKHURST ST # 194
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6748
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Country | US
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Telephone | 949-345-1186
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 23256
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License Number State | CA
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