Provider Demographics
NPI:1518181734
Name:BOSCH, DONALD STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:STEPHEN
Last Name:BOSCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2937 SANTA ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1641
Mailing Address - Country:US
Mailing Address - Phone:626-798-6623
Mailing Address - Fax:
Practice Address - Street 1:16 S OAKLAND AVE
Practice Address - Street 2:211
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2043
Practice Address - Country:US
Practice Address - Phone:626-795-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
CAPSY7174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical