Provider Demographics
NPI:1700441854
Name:DE ANDA PSYCHOLOGICAL SERVICES LTD
Entity Type:Organization
Organization Name:DE ANDA PSYCHOLOGICAL SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WRAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE ANDA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD 25484
Authorized Official - Phone:714-623-0997
Mailing Address - Street 1:13502 WHITTIER BLVD # H-507
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1945
Mailing Address - Country:US
Mailing Address - Phone:714-623-0997
Mailing Address - Fax:
Practice Address - Street 1:13502 WHITTIER BLVD # H-507
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1945
Practice Address - Country:US
Practice Address - Phone:714-623-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396993127OtherNPI