Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY229228 | CA |
Y | 103T00000X | Psychologist | PSY229228 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY229228 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY229228 | CA |
NPI | 1235464272 |
---|---|
Provider Name | Joan R. David |
First Address | Fountain Valley, CA 92708-5644 |
Second Address | Fountain Valley, CA 92708-5644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2009 |
Last Update Date | 08/10/2009 |