Provider Demographics
NPI:1205280773
Name:WALESZONIA, SURANEE (PHD)
Entity type:Individual
Prefix:DR
First Name:SURANEE
Middle Name:
Last Name:WALESZONIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SURANEE
Other - Middle Name:
Other - Last Name:ABEYESINHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-0712
Mailing Address - Country:US
Mailing Address - Phone:818-439-7033
Mailing Address - Fax:
Practice Address - Street 1:135 S STATE COLLEGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5805
Practice Address - Country:US
Practice Address - Phone:714-745-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical