Provider Demographics
NPI:1417342965
Name:LD NEUROPSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:LD NEUROPSYCHOLOGICAL SERVICES
Other - Org Name:DR. LANA DELSHADI
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELSHADI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:714-229-0094
Mailing Address - Street 1:10861 CHERRY ST STE 211
Mailing Address - Street 2:STE 211
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:714-229-0094
Mailing Address - Fax:714-229-0180
Practice Address - Street 1:10861 CHERRY ST STE 211
Practice Address - Street 2:STE 211
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:714-229-0094
Practice Address - Fax:714-229-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16895103G00000X, 103TA0700X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA585955Medicare UPIN
CAGE553AMedicare PIN