Provider Demographics
NPI:1780619783
Name:SVENSSON, TRAVIS K (MD, FNP, PMHNP, PHD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:K
Last Name:SVENSSON
Suffix:
Gender:M
Credentials:MD, FNP, PMHNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 24TH ST # 521
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3676
Mailing Address - Country:US
Mailing Address - Phone:415-775-7766
Mailing Address - Fax:415-641-1933
Practice Address - Street 1:4104 24TH ST # 521
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3676
Practice Address - Country:US
Practice Address - Phone:415-775-7766
Practice Address - Fax:415-641-1933
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80502208VP0000X, 2084P0800X, 208D00000X, 2084A0401X
CA95004106363LF0000X, 363LP0808X
CA780292163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G805021Medicaid
CA00G805021Medicaid
BC544ZMedicare PIN