MEDICARE: CALIFORNIA HEALTH PSYCHOLOGY PC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1427621234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA HEALTH PSYCHOLOGY PC

Provider Business Mailing Address
First Line	:	607 FOOTHILL BOULEVARD, #754
Second Line	:	LA CANADA
City	:	FLINTRIDGE
State	:	CA
Zip	:	91011-3402
Country	:	US
Telephone Number	:	646-820-9652
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 GIDDINGS RANCH RD
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-3827
Country	:	US
Telephone Number	:	631-786-9312
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. SHIBANI RAY-MAZUMDER
Credential	:	PHD
Telephone Number	:	631-786-9312

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	07/20/2021

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