Healthcare Provider Details

I. General information

NPI: 1659927499
Provider Name (Legal Business Name): VIVEK RAGHAVENDER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25550 HAWTHORNE BLVD STE 316
TORRANCE CA
90505-6832
US

IV. Provider business mailing address

25550 HAWTHORNE BLVD STE 316
TORRANCE CA
90505-6832
US

V. Phone/Fax

Practice location:
  • Phone: 323-325-1970
  • Fax:
Mailing address:
  • Phone: 323-325-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: