Provider Demographics
NPI:1033206701
Name:FROCK, SYLVA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SYLVA
Middle Name:
Last Name:FROCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7682 JULIETTE LOW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4176
Mailing Address - Country:US
Mailing Address - Phone:214-729-9797
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST.
Practice Address - Street 2:250
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:214-729-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31736103TC0700X
CA26465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161679901Medicaid
TX86836AOtherBCBS
TX8D4600Medicare ID - Type Unspecified