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General NPI Number Information
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NPI Number | 1356881080
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Entity Type | Organization
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Legal Business Name | JOHN FRAIRE ALDAVA IV, PHD, PSYCHOLOGY GROUP P.C.
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 1866 CLAYTON RD STE 103A
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City | CONCORD
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State | CA
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Zip | 94520-2566
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Country | US
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Telephone | 925-785-6682
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Fax |
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Provider Business Mailing Address
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Address Line | 1866 CLAYTON RD STE 103A
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City | CONCORD
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State | CA
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Zip | 94520-2566
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Country | US
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Telephone | 925-785-6682
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Fax |
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Authorized Official
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Title or Position | ASSISTANT
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Name | MS. CAROL BRINK
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Credential |
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Telephone | 925-785-6682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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