MEDICARE: DR. DESIREE DELAGARZA PURCELL DOCTORATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	PSY19575	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY19575	CA
3	103TC0700X	Clinical Psychologist	PSY19575	CA

General Provider Information

NPI Number	:	1003075235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DESIREE DELAGARZA PURCELL DOCTORATE

Provider Business Mailing Address
First Line	:	1968 S COAST HWY
Second Line	:	# 996
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:	949-370-9442
Fax Number	:	949-248-2230

Provider Business Practice Location Address
First Line	:	1968 S COAST HWY # 996
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:	949-370-9442
Fax Number	:	361-353-4408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	12/13/2023

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