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General NPI Number Information
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NPI Number | 1417342965
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Entity Type | Organization
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Legal Business Name | LD NEUROPSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 10861 CHERRY ST STE 211 STE 211
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-5402
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Country | US
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Telephone | 714-229-0094
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Fax | 714-229-0180
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Provider Business Mailing Address
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Address Line | 10861 CHERRY ST STE 211 STE 211
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-5402
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Country | US
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Telephone | 714-229-0094
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Fax | 714-229-0180
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Authorized Official
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Title or Position | OWNER
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Name | DR. LANA DELSHADI
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Credential | ED.D.
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Telephone | 714-229-0094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY16895
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | PSY16895
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY16895
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY16895
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License Number State | CA
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