Healthcare Provider Details

I. General information

NPI: 1326607920
Provider Name (Legal Business Name): FABIO EUGENIO BESU PASTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 11/02/2022
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UC DAVIS EARLY PSYCHOSIS PROGRAM 2230 STOCKTON BLVD
SACRAMENTO CA
95817
US

IV. Provider business mailing address

19 CALLE PERAL EDIFICIO LA PALMA SUITE 3-E
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3350
  • Fax: 916-734-7539
Mailing address:
  • Phone: 787-948-8428
  • Fax: 787-935-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: