| Doctor Name: | DR. CARLA BACK-MADRUGA |
| NPI Number: | 1073940086 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | PSY14950 |
| Business Practice Address: | 8055 W Manchester Ave Suite 235 Playa Del Rey, CA - 902937960 |
| Business Phone Number: | 3198279851 |
| Business Fax Number: | |
| Mailing Address: | 8055 W Manchester Ave, Suite 235 PLAYA DEL REY |
| State: | CA |
| Postal Code: | 902937960 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/04/2013 |
| NPI Last Update Date: | 10/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PSY14950 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |