=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720377559
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BABA SINGH PSY.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2011
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9985 SIERRA AVE MOB 2-6TH FLR
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92335-6720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-644-7930
-----------------------------------------------------
Fax | 626-765-9647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6577
-----------------------------------------------------
City | ALTADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91003-6577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-644-7930
-----------------------------------------------------
Fax | 626-765-9647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0004X
-----------------------------------------------------
Taxonomy Name | Health Psychologist
-----------------------------------------------------
License Number | PSY25299
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Psychologist
-----------------------------------------------------
License Number | PSY25299
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY25299
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------