Provider Demographics
NPI:1528372513
Name:DAVID L. ANTION, PH.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID L. ANTION, PH.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANTION
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-318-6885
Mailing Address - Street 1:745 S MARENGO AVE
Mailing Address - Street 2:102
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4735
Mailing Address - Country:US
Mailing Address - Phone:626-318-6885
Mailing Address - Fax:626-792-8028
Practice Address - Street 1:745 S MARENGO AVE
Practice Address - Street 2:102
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4735
Practice Address - Country:US
Practice Address - Phone:626-318-6885
Practice Address - Fax:626-792-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9037Medicare UPIN