Provider Demographics
NPI:1629136833
Name:FOX, DAVID DONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DONALD
Last Name:FOX
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 1:410 ARDEN AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1127
Mailing Address - Country:US
Mailing Address - Phone:818-246-3937
Mailing Address - Fax:
Practice Address - Street 1:410 ARDEN AVE
Practice Address - Street 2:STE 201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1127
Practice Address - Country:US
Practice Address - Phone:818-246-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6433103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADFCP6433Medicare ID - Type Unspecified