MEDICARE: DR. ELI MATTHEW VAN DUSEN PSY D, LMFT, LAADC

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	103TC0700X	Clinical Psychologist	32823	CA
2	106H00000X	Marriage & Family Therapist	53932	CA

General Provider Information

NPI Number	:	1518126010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELI MATTHEW VAN DUSEN PSY D, LMFT, LAADC

Provider Business Mailing Address
First Line	:	39583 CALADIUM DR
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92591-0363
Country	:	US
Telephone Number	:	760-278-1453
Fax Number	:

Provider Business Practice Location Address
First Line	:	7742 HERSCHEL AVE STE K
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-4444
Country	:	US
Telephone Number	:	760-278-1453
Fax Number	:

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	04/20/2026

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