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General NPI Number Information
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NPI Number | 1396967766
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Entity Type | Individual
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Provider Name | C. ROGER HASTINGS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 10/31/2020
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Provider Practice Location Address
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Address Line | 827 DEEP VALLEY DR STE 203
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3668
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Country | US
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Telephone | 310-995-0054
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Fax | 310-377-0056
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Provider Business Mailing Address
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Address Line | 827 DEEP VALLEY DR STE 203
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3668
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Country | US
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Telephone | 310-995-0054
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Fax | 310-377-0056
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY10334
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License Number State | CA
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