Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY16884 | CA |
N | 103T00000X | Psychologist | PSY16884 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY16884 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY16884 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY16884 | CA |
Y | 103G00000X | Clinical Psychologist | PSY16884 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY16884 | CA |
N | 103TC1900X | Counseling Psychologist | PSY16884 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY16884 | CA |
N | 103TF0000X | Family Psychologist | PSY16884 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY16884 | CA |
NPI | 1134271943 |
---|---|
Provider Name | Dr. John Fraire Aldava IV |
First Address | Concord, CA 94520-2498 |
Second Address | Concord, CA 94520-2555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 23/02/2017 |