Healthcare Provider Details

I. General information

NPI: 1225143993
Provider Name (Legal Business Name): ALAN JOHN FRIDLUND PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E ESPLANADE DR STE 320
OXNARD CA
93036-0506
US

IV. Provider business mailing address

3032 N VENTURA RD
OXNARD CA
93036-2272
US

V. Phone/Fax

Practice location:
  • Phone: 805-307-1535
  • Fax: 805-307-1535
Mailing address:
  • Phone: 805-307-1535
  • Fax: 805-307-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY8446
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: