Provider Demographics
NPI:1356565766
Name:FRANCISCO, ANTOINE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTOINE
Middle Name:
Last Name:FRANCISCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:FRANCISCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:250 FISCHER AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4515
Mailing Address - Country:US
Mailing Address - Phone:949-836-8522
Mailing Address - Fax:949-644-5371
Practice Address - Street 1:250 FISCHER AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4515
Practice Address - Country:US
Practice Address - Phone:949-836-8522
Practice Address - Fax:949-644-5371
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6247103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PSY6247OtherCALIFORNIA