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General NPI Number Information
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NPI Number | 1700441854
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Entity Type | Organization
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Legal Business Name | DE ANDA PSYCHOLOGICAL SERVICES LTD
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 13502 WHITTIER BLVD # H-507
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City | WHITTIER
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State | CA
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Zip | 90605-1945
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Country | US
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Telephone | 714-623-0997
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Fax |
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Provider Business Mailing Address
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Address Line | 13502 WHITTIER BLVD # H-507
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City | WHITTIER
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State | CA
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Zip | 90605-1945
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Country | US
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Telephone | 714-623-0997
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | WRAY E DE ANDA
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Credential | PSY.D 25484
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Telephone | 714-623-0997
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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 |
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License Number State |
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