Provider Demographics
NPI:1538458716
Name:CALIFORNIA GERIATRIC PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:CALIFORNIA GERIATRIC PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-907-4472
Mailing Address - Street 1:6335 ELMQUIST AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-3822
Mailing Address - Country:US
Mailing Address - Phone:562-907-4472
Mailing Address - Fax:
Practice Address - Street 1:6335 ELMQUIST AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-3822
Practice Address - Country:US
Practice Address - Phone:562-907-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty