Basic Information
| Provider Information | |||||||||
| NPI: | 1831733195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALM SPRINGS NEUROPSYCHOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2257 | ||||||||
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| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463040357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199268320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 E TAHQUITZ CANYON WAY STE 2 | ||||||||
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| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922626714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412575533 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2019 | ||||||||
| LastUpdateDate: | 02/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUILLAUMOT | ||||||||
| AuthorizedOfficialFirstName: | JULIEN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5412575533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 02/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.