Healthcare Provider Details

I. General information

NPI: 1598190886
Provider Name (Legal Business Name): THOMAS E DONAVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 IRVINE CENTER DR SUITE 800
IRVINE CA
92618-2923
US

IV. Provider business mailing address

7700 IRVINE CENTER DR STE 800
IRVINE CA
92618-3047
US

V. Phone/Fax

Practice location:
  • Phone: 949-528-6300
  • Fax: 562-213-2337
Mailing address:
  • Phone:
  • Fax: 562-213-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: