Provider Demographics
NPI:1316155716
Name:CONGO, DAVID GEORGE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE
Last Name:CONGO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23441 S POINTE DR STE 180
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1550
Mailing Address - Country:US
Mailing Address - Phone:949-452-9294
Mailing Address - Fax:949-452-0296
Practice Address - Street 1:23441 S POINTE DR STE 180
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1550
Practice Address - Country:US
Practice Address - Phone:949-452-9294
Practice Address - Fax:949-452-0296
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY13161OtherPSYCHOLOGIST'S LICENSE #