Basic Information
| Provider Information | |||||||||
| NPI: | 1073762928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVID | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11022 SANTA MONICA BLVD STE 270 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900257566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234010493 | ||||||||
| FaxNumber: | 3102731010 | ||||||||
| Practice Location | |||||||||
| Address1: | 11022 SANTA MONICA BLVD STE 270 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900257566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234010493 | ||||||||
| FaxNumber: | 3102731010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2008 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | PSY22018 | CA | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | PSY22018 | CA | N | Behavioral Health & Social Service Providers | Psychologist | 103TA0700X | PSY22018 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TB0200X | PSY22018 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | PSY22018 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | PSY220180 | 05 | CA | MEDICAID |