Healthcare Provider Details

I. General information

NPI: 1184915779
Provider Name (Legal Business Name): MICHAEL FRANC PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 STUDEBAKER RD STE 300
CERRITOS CA
90703-2548
US

IV. Provider business mailing address

PO BOX 6
IRVINE CA
92650-0006
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-7307
  • Fax:
Mailing address:
  • Phone: 562-924-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number22327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: