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NPI Code Detail

MEDICARE: JANA LORD PSY.D.

MEDICARE: JANA LORD PSY.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 PsychologistPSY19815CA
2103T00000XPsychologistPSY19815CA

General Provider Information

NPI Number : 1548311780
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANA LORD PSY.D.
Provider Business Mailing Address
First Line : 12450 VAN NUYS BLVD STE 100
Second Line :
City : PACOIMA
State : CA
Zip : 91331-1392
Country : US
Telephone Number : 323-823-8917
Fax Number :
Provider Business Practice Location Address
First Line : 12450 VAN NUYS BLVD STE 100
Second Line :
City : PACOIMA
State : CA
Zip : 91331-1392
Country : US
Telephone Number : 323-823-8917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2007
Last Update Date : 07/30/2014

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