Provider Demographics
NPI:1134271943
Name:ALDAVA, JOHN FRAIRE IV (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRAIRE
Last Name:ALDAVA
Suffix:IV
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 1:1655 GALINDO ST
Mailing Address - Street 2:APT 1251
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2498
Mailing Address - Country:US
Mailing Address - Phone:510-426-0018
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY STE 300
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4398
Practice Address - Country:US
Practice Address - Phone:925-785-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16884103TA0700X, 103TC0700X, 103TC1900X, 103TF0000X, 103T00000X, 103TB0200X, 103TC1900X, 103T00000X
CAPSY166103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral