Healthcare Provider Details

I. General information

NPI: 1780619783
Provider Name (Legal Business Name): TRAVIS K SVENSSON MD, FNP, PMHNP, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 EDWARDS CT STE 105
BURLINGAME CA
94010-2421
US

IV. Provider business mailing address

25 EDWARDS CT STE 105
BURLINGAME CA
94010-2421
US

V. Phone/Fax

Practice location:
  • Phone: 650-342-1966
  • Fax: 650-685-6552
Mailing address:
  • Phone: 650-342-1966
  • Fax: 650-685-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number780292
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberG80502
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG80502
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG80502
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004106
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95004106
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG80502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: