Individual
CARLOS FAYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
11374 MOUNTAIN VIEW AVE, SUITE A, LOMA LINDA, CA 92354-3830
(909) 558-4505
Mailing address
54701 FILE NUMBER, LOS ANGELES, CA 90074-4701
(909) 558-3111
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY12024
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY120240
—
CA
Enumeration date
07/07/2006
Last updated
09/26/2007
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