MEDICARE: ANDREW CLARK DEAN

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	103G00000X	Clinical Neuropsychologist	PSY21280	CA

General Provider Information

NPI Number	:	1295142289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW CLARK DEAN

Provider Business Mailing Address
First Line	:	1654 S ORANGE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5314
Country	:	US
Telephone Number	:	310-892-3235
Fax Number	:	310-872-1588

Provider Business Practice Location Address
First Line	:	1654 S ORANGE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5314
Country	:	US
Telephone Number	:	310-892-3235
Fax Number	:	310-872-1588

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANDREW CLARK DEAN
Credential	:	PH.D.
Telephone Number	:	310-892-3235

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	08/05/2015

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