Healthcare Provider Details

I. General information

NPI: 1396652756
Provider Name (Legal Business Name): MUSA FAIDI ESQ., AMFT PENDING#
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY STE 634
LAGUNA BEACH CA
92651-3681
US

IV. Provider business mailing address

2112 QUAIL LAKES DR
STOCKTON CA
95207-4629
US

V. Phone/Fax

Practice location:
  • Phone: 619-547-1856
  • Fax:
Mailing address:
  • Phone: 209-406-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: