Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY 11496 | CA |
N | 103T00000X | Psychologist | PSY 11496 | CA |
Y | 103G00000X | Clinical Psychologist | PSY 11496 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 11496 | CA |
N | 103TH0100X | Health Service | PSY 11496 | CA |
NPI | 1114023603 |
---|---|
Provider Name | Dr. David Frederick Mann |
First Address | Santa Monica, CA 90403-5061 |
Second Address | Santa Monica, CA 90403-5061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 21/09/2010 |