Basic Information
| Provider Information | |||||||||
| NPI: | 1326607920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BESU PASTOR | ||||||||
| FirstName: | FABIO | ||||||||
| MiddleName: | EUGENIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 CALLE PERAL EDIFICIO LA PALMA | ||||||||
| Address2: | SUITE 3-E | ||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879488428 | ||||||||
| FaxNumber: | 7879357163 | ||||||||
| Practice Location | |||||||||
| Address1: | UC DAVIS EARLY PSYCHOSIS PROGRAM | ||||||||
| Address2: | 2230 STOCKTON BLVD | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167343350 | ||||||||
| FaxNumber: | 9167347539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2019 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.