Healthcare Provider Details

I. General information

NPI: 1548870728
Provider Name (Legal Business Name): DR. SUPATRA TOVAR & ASSOCIATES, A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 12/24/2022
Certification Date: 12/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N LAKE AVE STE 600
PASADENA CA
91101-5129
US

IV. Provider business mailing address

301 N LAKE AVE STE 600
PASADENA CA
91101-5129
US

V. Phone/Fax

Practice location:
  • Phone: 626-674-2639
  • Fax:
Mailing address:
  • Phone: 626-674-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. SUPATRA H TOVAR
Title or Position: OWNER
Credential: PSYD, RD
Phone: 626-674-2639