Provider Demographics
NPI:1154365435
Name:UNRUH, DONALD L (PHD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:UNRUH
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 1:415 W ROUTE 66
Mailing Address - Street 2:202
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4335
Mailing Address - Country:US
Mailing Address - Phone:626-963-4467
Mailing Address - Fax:626-963-9543
Practice Address - Street 1:415 W ROUTE 66
Practice Address - Street 2:202
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-963-4467
Practice Address - Fax:626-963-9543
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00CP78420Medicaid
CAR30961Medicare UPIN
CACP7842Medicare ID - Type UnspecifiedMCARE