Provider Demographics
NPI:1245528447
Name:SHARON GERSTENZANG
Entity type:Organization
Organization Name:SHARON GERSTENZANG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARGOT-DREGNE
Authorized Official - Last Name:GERSTENZANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-964-3126
Mailing Address - Street 1:10101 SLATER AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4741
Mailing Address - Country:US
Mailing Address - Phone:714-964-3126
Mailing Address - Fax:714-964-5784
Practice Address - Street 1:10101 SLATER AVE STE 205
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4741
Practice Address - Country:US
Practice Address - Phone:714-964-3126
Practice Address - Fax:714-964-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty