Provider Demographics
NPI:1235401860
Name:POMPA-CRAVEN, PAULA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:POMPA-CRAVEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8511
Mailing Address - Country:US
Mailing Address - Phone:818-660-2789
Mailing Address - Fax:818-510-3258
Practice Address - Street 1:1570 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8511
Practice Address - Country:US
Practice Address - Phone:818-660-2789
Practice Address - Fax:818-510-3258
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24800103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities