Healthcare Provider Details

I. General information

NPI: 1689828634
Provider Name (Legal Business Name): CLAUDIA FAGGOUSEH M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PACIFIC COAST HWY SUITE 304A
HERMOSA BEACH CA
90254-2757
US

IV. Provider business mailing address

PO BOX 404
MANHATTAN BEACH CA
90267-0404
US

V. Phone/Fax

Practice location:
  • Phone: 310-421-4264
  • Fax:
Mailing address:
  • Phone: 310-421-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: