Individual
DR. ROGER KENNETH LIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
509 N SEPULVEDA BLVD, SUITE 204, MANHATTAN BEACH, CA 90266-6746
(310) 374-1221
(310) 214-0648
Mailing address
509 N SEPULVEDA BLVD, SUITE 204, MANHATTAN BEACH, CA 90266-6746
(310) 374-1221
(310) 214-0648
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY819
HI
103G00000X
Clinical Neuropsychologist
Primary
PSY9830
CA
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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