Provider Demographics
NPI:1548312150
Name:ANTION, DAVID LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:ANTION
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 S MARENGO AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4737
Mailing Address - Country:US
Mailing Address - Phone:562-803-6545
Mailing Address - Fax:626-792-8028
Practice Address - Street 1:745 S MARENGO AVE
Practice Address - Street 2:STE 102
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4737
Practice Address - Country:US
Practice Address - Phone:562-803-6545
Practice Address - Fax:626-792-8028
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9037103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP 9037Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER