Individual
DR. EDWARD DE ANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
136 N CHESTER AVE, PASADENA, CA 91106-1805
(619) 754-1928
Mailing address
136 N CHESTER AVE, PASADENA, CA 91106-1805
(619) 754-1928
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
33988
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92-2323219
—
CA
Enumeration date
09/30/2019
Last updated
04/17/2024
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