Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 18256 | CA |
N | 103TC0700X | Clinical Psychologist | 18256 | CA |
N | 103G00000X | Clinical Psychologist | 18256 | CA |
N | 103TC0700X | Clinical Psychologist | 18256 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 18256 | CA |
NPI | 1073667481 |
---|---|
Provider Name | Dr. Andre Dirk Van Rooyen |
First Address | Arcadia, CA 91006-2568 |
Second Address | Arcadia, CA 91006-2568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |