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General NPI Number Information
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NPI Number | 1982945689
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Entity Type | Organization
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Legal Business Name | LEMON HEIGHTS HOLDINGS INC.
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 17215 STUDEBAKER ROAD SUITE 110
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City | CERRITOS
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State | CA
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Zip | 90703-2521
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Country | US
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Telephone | 562-860-2210
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Fax | 562-860-1154
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Provider Business Mailing Address
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Address Line | PO BOX 2089
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City | ARTESIA
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State | CA
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Zip | 90702-2089
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Country | US
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Telephone | 562-860-2210
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Fax | 714-940-0941
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Authorized Official
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Title or Position | OWNER-OFFICER
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Name | ROBERT NILS JOHANSEN
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Credential | PH.D.
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Telephone | 562-860-2210
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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 | PSY10129
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License Number State | CA
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