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General NPI Number Information
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NPI Number | 1659652717
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Entity Type | Individual
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Provider Name | ANGELA DAWN EASTVOLD PHD
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Gender | Female
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 120 BIRMINGHAM DR STE 110A
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City | CARDIFF BY THE SEA
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State | CA
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Zip | 92007-1737
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Country | US
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Telephone | 760-420-2640
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Fax |
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Provider Business Mailing Address
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Address Line | 120 BIRMINGHAM DR STE 110A
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City | CARDIFF BY THE SEA
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State | CA
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Zip | 92007-1737
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Country | US
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Telephone | 760-420-2640
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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 | 80249832501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | CA-29589
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License Number State | CA
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