Provider Demographics
NPI:1740601228
Name:VADO, ROBERTO J (EDD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:J
Last Name:VADO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 W SARAH ST
Mailing Address - Street 2:APT 7
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3816
Mailing Address - Country:US
Mailing Address - Phone:323-401-2958
Mailing Address - Fax:
Practice Address - Street 1:4210 W SARAH ST
Practice Address - Street 2:APT 7
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3816
Practice Address - Country:US
Practice Address - Phone:323-401-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist