1063433183 NPI number — DR. BERNARD FRANKLIN NATELSON PSY.D.

Table of content: DR. BERNARD FRANKLIN NATELSON PSY.D. (NPI 1063433183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063433183 NPI number — DR. BERNARD FRANKLIN NATELSON PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NATELSON
Provider First Name:
BERNARD
Provider Middle Name:
FRANKLIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063433183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
242 TERMINO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90803-6149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-818-1258
Provider Business Mailing Address Fax Number:
562-594-4676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10900 LOS ALAMITOS BLVD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-818-1258
Provider Business Practice Location Address Fax Number:
562-594-4676
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 6745 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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