Individual
DR. GRACE E HAZELTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4212 1/2 OVERLAND AVE, CULVER CITY, CA 90230-3736
(323) 553-2205
Mailing address
4212 1/2 OVERLAND AVE, CULVER CITY, CA 90230-3736
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY33148
CA
103T00000X
Psychologist
PSY33418
CA
Other
Enumeration date
01/04/2017
Last updated
05/16/2022
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