MEDICARE: DR. DAVID M LECHUGA PHD

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	PSY606	HI
2	103G00000X	Clinical Neuropsychologist	PSY10139	CA
3	103TC0700X	Clinical Psychologist	3274	AZ
4	103TC0700X	Clinical Psychologist	PSY10139	CA

General Provider Information

NPI Number	:	1982712386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M LECHUGA PHD

Provider Business Mailing Address
First Line	:	13 ORCHARD ROAD
Second Line	:	SUITE 103
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-8321
Country	:	US
Telephone Number	:	949-837-3358
Fax Number	:	949-837-0274

Provider Business Practice Location Address
First Line	:	13 ORCHARD ROAD
Second Line	:	SUITE 103
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-8321
Country	:	US
Telephone Number	:	949-837-3358
Fax Number	:	949-837-0274

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

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	08/08/2024

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