Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY12304 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY12304 | CA |
N | 103TF0200X | Forensic Psychologist | PSY12304 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY12304 | CA |
NPI | 1215005608 |
---|---|
Provider Name | Edward Dunbar |
First Address | El Segundo, CA 90245-2801 |
Second Address | El Segundo, CA 90245-2801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 27/11/2012 |