Healthcare Provider Details

I. General information

NPI: 1548346851
Provider Name (Legal Business Name): FIONA VAJK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 1ST ST SUITE 242
CLAREMONT CA
91711-4736
US

IV. Provider business mailing address

250 W 1ST ST SUITE 242
CLAREMONT CA
91711-4736
US

V. Phone/Fax

Practice location:
  • Phone: 909-621-9023
  • Fax: 909-621-8482
Mailing address:
  • Phone: 909-621-9023
  • Fax: 909-621-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: