Provider Demographics
NPI:1225143993
Name:FRIDLUND, ALAN JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOHN
Last Name:FRIDLUND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 N VENTURA RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2272
Mailing Address - Country:US
Mailing Address - Phone:805-307-1535
Mailing Address - Fax:805-307-1535
Practice Address - Street 1:500 E ESPLANADE DR
Practice Address - Street 2:STE 320
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0506
Practice Address - Country:US
Practice Address - Phone:805-307-1535
Practice Address - Fax:805-307-1535
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8446103TC0700X
CAPSY8446103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R31443Medicare UPIN
CACP8446CMedicare PIN