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Provider Information for 1578594313


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Dr. CAROL LYNN GANDOLFO Psy D


Sex: Female

NPI: 1578594313
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1578594313
Enumeration Date2006-07-06
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 1600 9TH STREET
ROOM 205 MAILSTOP 2-3
SACRAMENTO, CA 95814-6414
United States

Phone: 916-654-2431 | Fax:916-654-3186
 
Primary Practice Address 3530 WEST POMONA BLVD
POMONA, CA 91769-0100
United States

Phone: 909-595-1221 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 103TM1800X - Psychologist - Intellectual & Developmental DisabilitiesCAPSY16933