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Individual

TRAVIS FOGEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
11406 LOMA LINDA DR, LOMA LINDA, CA 92354-3711
(909) 558-6144
(909) 558-3905
Mailing address
54701 FILE NUMBER, LOS ANGELES, CA 90074-4701
(909) 558-3111
(909) 558-3905

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY17746
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PSY177460
CA
Enumeration date
07/07/2006
Last updated
07/08/2007
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