Provider Demographics
NPI:1043237787
Name:ATHAR-MACDONALD, HUMA (PSYD)
Entity Type:Individual
Prefix:
First Name:HUMA
Middle Name:
Last Name:ATHAR-MACDONALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18627 BROOKHURST ST
Mailing Address - Street 2:STE 520
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6748
Mailing Address - Country:US
Mailing Address - Phone:310-991-6133
Mailing Address - Fax:
Practice Address - Street 1:18627 BROOKHURST ST
Practice Address - Street 2:STE 520
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6748
Practice Address - Country:US
Practice Address - Phone:310-991-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17573Medicare ID - Type Unspecified
P67769Medicare UPIN