Healthcare Provider Details

I. General information

NPI: 1548949977
Provider Name (Legal Business Name): MINOO DARGAH PSY D PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SILVERADO
IRVINE CA
92618-8888
US

IV. Provider business mailing address

4521 CAMPUS DR # 231
IRVINE CA
92612-2621
US

V. Phone/Fax

Practice location:
  • Phone: 949-776-4004
  • Fax:
Mailing address:
  • Phone: 949-776-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MINOO DARGAH
Title or Position: CEO
Credential:
Phone: 949-776-4004