Provider Demographics
NPI:1063608230
Name:CARVAJAL, FRANKLIN (PHD)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:
Last Name:CARVAJAL
Suffix:
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 1:1436 S SHERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3507
Mailing Address - Country:US
Mailing Address - Phone:540-818-4304
Mailing Address - Fax:323-488-9569
Practice Address - Street 1:3567 WESLEY ST
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2432
Practice Address - Country:US
Practice Address - Phone:540-818-4304
Practice Address - Fax:323-488-9569
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist