Provider Demographics
NPI:1891335196
Name:TOBIAS, JOHN DAVID JR
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:TOBIAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N GOLDEN CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3959
Mailing Address - Country:US
Mailing Address - Phone:630-234-6067
Mailing Address - Fax:
Practice Address - Street 1:550 N GOLDEN CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3959
Practice Address - Country:US
Practice Address - Phone:630-234-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR01360315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)