Provider Demographics
NPI:1215005608
Name:DUNBAR, EDWARD (EDD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:DUNBAR
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 N DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2801
Mailing Address - Country:US
Mailing Address - Phone:310-536-0211
Mailing Address - Fax:310-536-0215
Practice Address - Street 1:877 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2801
Practice Address - Country:US
Practice Address - Phone:310-536-0211
Practice Address - Fax:310-536-0215
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12304103TC0700X, 103TF0200X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation