Individual
TIMOTHY ALAN LUNDGREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
1020 S ARROYO PKWY, PASADENA, CA 91105-3911
(626) 294-1079
Mailing address
713 GAILLARD ST, LA VERNE, CA 91750-3827
(909) 217-8871
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
36282
CA
Other
Enumeration date
02/27/2012
Last updated
02/27/2012
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