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General NPI Number Information
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NPI Number | 1184174583
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Entity Type | Individual
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Provider Name | FRED LOYA III PHD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 150 MUIR RD
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City | MARTINEZ
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State | CA
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Zip | 94553-4668
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Country | US
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Telephone | 925-372-2432
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 9TH AVE
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City | OAKLAND
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State | CA
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Zip | 94606-2124
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Country | US
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Telephone | 909-226-7314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 28519
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License Number State | CA
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