Provider Demographics
NPI:1407010374
Name:CHIDEKEL, DANA (PHDL)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:CHIDEKEL
Suffix:
Gender:F
Credentials:PHDL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18321 VENTURA BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4248
Mailing Address - Country:US
Mailing Address - Phone:818-705-4305
Mailing Address - Fax:818-705-4307
Practice Address - Street 1:18321 VENTURA BLVD STE 510
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4248
Practice Address - Country:US
Practice Address - Phone:818-705-4305
Practice Address - Fax:818-705-4307
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14261103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist