Provider Demographics
NPI:1982712386
Name:LECHUGA, DAVID M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:LECHUGA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ORCHARD ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8321
Mailing Address - Country:US
Mailing Address - Phone:949-837-3358
Mailing Address - Fax:949-837-0274
Practice Address - Street 1:13 ORCHARD ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8321
Practice Address - Country:US
Practice Address - Phone:949-837-3358
Practice Address - Fax:949-837-0274
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10139103G00000X
HIPSY606103TC0700X
AZ3274103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEY763ZMedicare PIN