Provider Demographics
NPI:1205337524
Name:TOVAR, SHAWN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:TOVAR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:TOVAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:10421 S FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-4423
Mailing Address - Country:US
Mailing Address - Phone:323-418-4216
Mailing Address - Fax:
Practice Address - Street 1:10421 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-4423
Practice Address - Country:US
Practice Address - Phone:323-418-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871983106Medicaid