Doctor Name: | MR. STANLEY E LUNDE |
NPI Number: | 1033219928 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | PSY5515 |
Business Practice Address: | 3530 Pomona Blvd Pomona, CA - 917683238 |
Business Phone Number: | 9095951221 |
Business Fax Number: | |
Mailing Address: | 1600 9th St, SACRAMENTO |
State: | CA |
Postal Code: | 958146404 |
Phone Number: | 9166542431 |
Fax Number: | 9166543186 |
NPI Enumeration Date: | 09/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TM1800X |
License Number: | PSY5515 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Mental Retardation & Developmental Disabilities |
Taxonomy Definition: |