Provider Demographics
NPI:1396993127
Name:DE ANDA, WRAY E (PSYD)
Entity type:Individual
Prefix:DR
First Name:WRAY
Middle Name:E
Last Name:DE ANDA
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 1:1940 W ORANGEWOOD AVE
Mailing Address - Street 2:SUITE 110-4
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2009
Mailing Address - Country:US
Mailing Address - Phone:714-623-0997
Mailing Address - Fax:
Practice Address - Street 1:13601 WHITTIER BLVD STE 310
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1969
Practice Address - Country:US
Practice Address - Phone:714-623-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-25484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical