Active NPI
Fulviu Mihai Fodoreanu, PSYD
- Clinical Psychologist
- Covina, CA
National Provider Identifier
1114394152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSB94027580
- Practice address
- 536 S 2ND Ave
Covina, CA 91723-3043 - Phone
- (626) 479-2029
- Fax
- (626) 479-2029
- NPI assigned
- Aug 25, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSB94027580 | CA | Primary |
Addresses
Primary practice location
536 S 2ND Ave
Covina, CA 91723-3043
Mailing address
PO Box 9254
San Bernardino, CA 92427-0254
Phone (844) 376-4424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB94027580 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691366400000",
"number": "1114394152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9254",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924270254",
"telephone_number": "844-376-4424",
"fax_number": "844-376-4424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "536 S 2ND AVE",
"city": "COVINA",
"state": "CA",
"postal_code": "917233043",
"telephone_number": "626-479-2029",
"fax_number": "626-479-2029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FODOREANU",
"first_name": "FULVIU",
"middle_name": "MIHAI",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-25",
"last_updated": "2023-08-07",
"certification_date": "2023-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSB94027580",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.