Provider Demographics
NPI:1114989282
Name:VERMUND, ANITA TORUND (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:TORUND
Last Name:VERMUND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-0707
Mailing Address - Country:US
Mailing Address - Phone:714-402-6437
Mailing Address - Fax:949-219-0092
Practice Address - Street 1:19742 MACARTHUR BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2432
Practice Address - Country:US
Practice Address - Phone:714-402-6437
Practice Address - Fax:949-219-0092
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16174Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST