Healthcare Provider Details

I. General information

NPI: 1265839138
Provider Name (Legal Business Name): FRANCISCO CHAVES PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 205
PASADENA CA
91101-2028
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 205
PASADENA CA
91101-2028
US

V. Phone/Fax

Practice location:
  • Phone: 626-788-1978
  • Fax:
Mailing address:
  • Phone: 626-788-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY27569
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberPSY27569
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB 94020704
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSB 94020704
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: