Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY16895 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY16895 | CA |
N | 103G00000X | Clinical Psychologist | PSY16895 | CA |
N | 103TC0700X | Clinical Psychologist | PSY16895 | CA |
NPI | 1003862137 |
---|---|
Provider Name | Dr. Lana Delshadi |
First Address | Los Alamitos, CA 90720-5402 |
Second Address | Los Alamitos, CA 90720-5402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P24716 | (02) | CA |