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NPI Code Detail

MEDICARE: DR. SUPATRA TOVAR & ASSOCIATES, A PSYCHOLOGICAL CORPORATION

MEDICARE: DR. SUPATRA TOVAR & ASSOCIATES, A PSYCHOLOGICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1548870728
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. SUPATRA TOVAR & ASSOCIATES, A PSYCHOLOGICAL CORPORATION
Provider Business Mailing Address
First Line : 301 N LAKE AVE STE 600
Second Line :
City : PASADENA
State : CA
Zip : 91101-5129
Country : US
Telephone Number : 626-674-2639
Fax Number :
Provider Business Practice Location Address
First Line : 301 N LAKE AVE STE 600
Second Line :
City : PASADENA
State : CA
Zip : 91101-5129
Country : US
Telephone Number : 626-674-2639
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. SUPATRA H TOVAR
Credential : PSYD, RD
Telephone Number : 626-674-2639
Provider Enumeration Date : 08/03/2020
Last Update Date : 12/24/2022

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