Provider Demographics
NPI:1952503617
Name:VONDA L. PELTO, PH.D.
Entity Type:Organization
Organization Name:VONDA L. PELTO, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:LORETTA
Authorized Official - Last Name:PELTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-493-0923
Mailing Address - Street 1:3310 N EL DORADO DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3235
Mailing Address - Country:US
Mailing Address - Phone:562-493-0923
Mailing Address - Fax:
Practice Address - Street 1:3310 N EL DORADO DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3235
Practice Address - Country:US
Practice Address - Phone:562-493-0923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8309103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8309Medicare ID - Type Unspecified