MEDICARE: ARIEL ECKFELD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	30913	CA

General Provider Information

NPI Number	:	1033545801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL ECKFELD PH.D.

Provider Business Mailing Address
First Line	:	578 S EVENINGSONG LN
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808-1616
Country	:	US
Telephone Number	:	973-951-6940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 BAYSIDE DR STE 2
Second Line	:
City	:	CORONA DEL MAR
State	:	CA
Zip	:	92625-1711
Country	:	US
Telephone Number	:	949-783-9590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2013
Last Update Date	:	08/27/2019

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