Doctor Name: | DR. LENA RIVERA ETEMAD |
NPI Number: | 1346515913 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | PSY24497 |
Business Practice Address: | 29050 S Western Ave Ste 123 Rancho Palos Verdes, CA - 902750834 |
Business Phone Number: | 3105198877 |
Business Fax Number: | |
Mailing Address: | 16121 Spectrum, IRVINE |
State: | CA |
Postal Code: | 926183410 |
Phone Number: | 5616322319 |
Fax Number: | |
NPI Enumeration Date: | 03/15/2012 |
NPI Last Update Date: | 03/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY24497 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |