Healthcare Provider Details

I. General information

NPI: 1760972467
Provider Name (Legal Business Name): FRANCISCO JAVIER IRIBARREN MSW-PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 WILSHIRE BLVD STE 800
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

440 VETERAN AVE APT 404
LOS ANGELES CA
90024-1997
US

V. Phone/Fax

Practice location:
  • Phone: 323-456-8686
  • Fax: 323-544-6186
Mailing address:
  • Phone: 310-430-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY30012
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: