MEDICARE: SUNRISE PSYCHOLOGICAL ASSOCIATES

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	103T00000X	Psychologist	22853	CA

General Provider Information

NPI Number	:	1770026189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE PSYCHOLOGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	320 PINE AVENUE
Second Line	:	SUITE 608
City	:	LONG BEACH
State	:	CA
Zip	:	90802
Country	:	US
Telephone Number	:	562-595-3955
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 PINE AVE
Second Line	:	SUITE 608
City	:	LONG BEACH
State	:	CA
Zip	:	90802-2315
Country	:	US
Telephone Number	:	562-595-3955
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORK
Name	:	SOMPIA PAIGNE
Credential	:	LCSW
Telephone Number	:	562-472-5372

Provider Enumeration Date	:	12/02/2016
Last Update Date	:	12/05/2016

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