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General NPI Number Information
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NPI Number | 1982895421
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL ASSESSMENT SERVICES
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 2107 N. BROADWAY #207
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City | SANTA ANA
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State | CA
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Zip | 92706
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Country | US
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Telephone | 714-972-0040
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Fax | 714-972-0477
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Provider Business Mailing Address
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Address Line | PO BOX 6299
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-6200
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Country | US
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Telephone | 714-972-0040
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Fax | 714-972-0477
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Authorized Official
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Title or Position | MPN COORDINATOR
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Name | MS. EMY ZORILLA
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Credential |
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Telephone | 714-972-0040
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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 | PSY12317
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License Number State | CA
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