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General NPI Number Information
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NPI Number | 1972951689
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Entity Type | Organization
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Legal Business Name | PSYCHCENTRAL
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 06/03/2016
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Provider Practice Location Address
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Address Line | 500 EAST E STREET SUITE 314
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City | ONTARIO
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State | CA
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Zip | 91764
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Country | US
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Telephone | 714-510-2738
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Fax |
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Provider Business Mailing Address
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Address Line | 500 EAST E STREET SUITE 314
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City | ONTARIO
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State | CA
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Zip | 91764
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Country | US
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Telephone | 714-510-2738
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. NHUNG PHAN
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Credential | PSY.D.
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Telephone | 714-510-2738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 28271
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License Number State | CA
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