Healthcare Provider Details

I. General information

NPI: 1134271943
Provider Name (Legal Business Name): JOHN FRAIRE ALDAVA IV PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/16/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MAYHEW WAY STE 300
PLEASANT HILL CA
94523-4398
US

IV. Provider business mailing address

1655 GALINDO ST APT 1251
CONCORD CA
94520-2498
US

V. Phone/Fax

Practice location:
  • Phone: 925-785-6682
  • Fax:
Mailing address:
  • Phone: 510-426-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY166
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY16884
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY16884
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16884
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY16884
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY16884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: