Provider Demographics
NPI:1851452478
Name:FRAZAO, VICTOR ALMEIDA (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ALMEIDA
Last Name:FRAZAO
Suffix:
Gender:M
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3505 CAMINO DEL RIO S
Mailing Address - Street 2:#238
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4002
Mailing Address - Country:US
Mailing Address - Phone:619-280-2868
Mailing Address - Fax:619-287-6796
Practice Address - Street 1:3505 CAMINO DEL RIO S
Practice Address - Street 2:#238
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4002
Practice Address - Country:US
Practice Address - Phone:619-280-2868
Practice Address - Fax:619-287-6796
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5677103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 5677OtherPSYCHOLOGY LICENSE
CAPSY 5677OtherPSYCHOLOGY LICENSE