Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY22018 | CA |
N | 103TC0700X | Clinical Psychologist | PSY22018 | CA |
N | 102L00000X | Psychologist | PSY22018 | CA |
N | 103T00000X | Psychologist | PSY22018 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY22018 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY22018 | CA |
Y | 103G00000X | Clinical Psychologist | PSY22018 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY22018 | CA |
NPI | 1073762928 |
---|---|
Provider Name | Dr. Steven David |
First Address | Los Angeles, CA 90025-7566 |
Second Address | Los Angeles, CA 90025-7566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 15/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY220180 | (05) | CA |