Provider Demographics
NPI:1528134525
Name:MACDONALD, DUSTIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:MACDONALD
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 1:500 CITY PKWY W STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2941
Mailing Address - Country:US
Mailing Address - Phone:714-480-6600
Mailing Address - Fax:
Practice Address - Street 1:500 CITY PKWY W STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2941
Practice Address - Country:US
Practice Address - Phone:714-480-6600
Practice Address - Fax:714-568-4527
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25697103T00000X
CAPSY25697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist