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NPI Code Detail

MEDICARE: DR. AFSHIN POURREZA PSY, D.

MEDICARE: DR. AFSHIN POURREZA PSY, 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
1106H00000XMarriage & Family Therapist52366CA

General Provider Information

NPI Number : 1396089645
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AFSHIN POURREZA PSY, D.
Provider Business Mailing Address
First Line : 23465 VIA RONDA
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92691-2232
Country : US
Telephone Number : 714-309-8454
Fax Number :
Provider Business Practice Location Address
First Line : 4199 CAMPUS DR STE 550
Second Line :
City : IRVINE
State : CA
Zip : 92612-4694
Country : US
Telephone Number : 949-422-4488
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2012
Last Update Date : 11/26/2012

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