MEDICARE: DR. GREG S. STANFORD 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
1	103TC0700X	Clinical Psychologist	PSY26271	CA

General Provider Information

NPI Number	:	1558484204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREG S. STANFORD PSY.D.

Provider Business Mailing Address
First Line	:	150 N SANTA ANITA AVE STE 735
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3145
Country	:	US
Telephone Number	:	626-415-4452
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 N SANTA ANITA AVE STE 735
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3145
Country	:	US
Telephone Number	:	626-415-4452
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	09/13/2018

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