Provider Demographics
NPI:1518143353
Name:PAVLOV, ANNA F (PHD)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:F
Last Name:PAVLOV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1770 N ORANGE GROVE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3027
Mailing Address - Country:US
Mailing Address - Phone:909-469-9494
Mailing Address - Fax:909-620-7285
Practice Address - Street 1:1770 N ORANGE GROVE AVE
Practice Address - Street 2:#101
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3027
Practice Address - Country:US
Practice Address - Phone:909-469-9494
Practice Address - Fax:909-620-7285
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14488103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP14488AMedicare PIN