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NPI Code Detail

MEDICARE: DR. ROGER E. DAFTER PH.D.

MEDICARE: DR. ROGER E. DAFTER PH.D.
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
1103TC0700XClinical PsychologistPSY 8184CA

General Provider Information

NPI Number : 1134216948
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER E. DAFTER PH.D.
Provider Business Mailing Address
First Line : 13111 SHERRY LANE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049
Country : US
Telephone Number : 310-597-9977
Fax Number :
Provider Business Practice Location Address
First Line : 2444 WILSHIRE BLVD STE 506
Second Line :
City : SANTA MONICA
State : CA
Zip : 90403-5814
Country : US
Telephone Number : 310-597-9977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 11/17/2023

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