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NPI Code Detail

MEDICARE: DR. FREDRICA JILL GOVER PH.D.

MEDICARE:  DR. FREDRICA JILL GOVER  PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist13880CA
2103T00000XPsychologistPSY13880CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669496899
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FREDRICA JILL GOVER PH.D.
Provider Business Mailing Address
First Line : 1835 N. VIA MIRALESTE #1618
Second Line :
City : PALM SPRINGS
State : CA
Zip : 92262
Country : US
Telephone Number : 760-832-9631
Fax Number : 760-832-9631
Provider Business Practice Location Address
First Line : 611 S PALM CANYON DR
Second Line : SUITE 201
City : PALM SPRINGS
State : CA
Zip : 92264-7213
Country : US
Telephone Number : 760-416-7899
Fax Number : 760-416-7786
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/10/2013

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