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NPI Code Detail

MEDICARE: AZADEH JALALI

MEDICARE: AZADEH JALALI
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
1101Y00000XCounselor
2225400000XRehabilitation Practitioner
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1942670518
Entity Type Code : Individual
Provider Name (Legal Business Name) : AZADEH JALALI
Provider Business Mailing Address
First Line : 1950 S SUNWEST LN STE 200
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-3248
Country : US
Telephone Number : 909-252-4010
Fax Number : 909-252-4055
Provider Business Practice Location Address
First Line : 1950 S SUNWEST LN STE 200
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-3248
Country : US
Telephone Number : 909-252-4010
Fax Number : 909-252-4055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2015
Last Update Date : 07/01/2022

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Directions to “ AZADEH JALALI ” Practice Location

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