Provider Demographics
NPI:1619298841
Name:OBERLANDER, DORIS A (PSYD)
Entity Type:Individual
Prefix:MISS
First Name:DORIS
Middle Name:A
Last Name:OBERLANDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S PALMETTO AVE APT F
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-4949
Mailing Address - Country:US
Mailing Address - Phone:909-984-0904
Mailing Address - Fax:
Practice Address - Street 1:900 QUEBEC AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-9715
Practice Address - Country:US
Practice Address - Phone:559-992-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CA28373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional