Healthcare Provider Details

I. General information

NPI: 1194951244
Provider Name (Legal Business Name): FLORA-TOSTADO PSYCHOLOGISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
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 TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5414
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number5414
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number5414
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5414
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN FLORA-TOSTADO
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D. PSYCHOLOGIST
Phone: 949-677-7741