| NPI | 1659518835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK KEVIN WANGBERG Clinical Psychologist 714-369-5117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY21059) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2009-01-09 |