Healthcare Provider Details

I. General information

NPI: 1053418319
Provider Name (Legal Business Name): JOHN FLORA-TOSTADO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 S POINTE DR SUITE 190
LAGUNA HILLS CA
92653-1547
US

IV. Provider business mailing address

23461 S POINTE DR SUITE 190
LAGUNA HILLS CA
92653-1547
US

V. Phone/Fax

Practice location:
  • Phone: 949-677-7741
  • Fax: 949-586-8508
Mailing address:
  • Phone: 949-677-7741
  • Fax: 949-586-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: