Healthcare Provider Details

I. General information

NPI: 1154494482
Provider Name (Legal Business Name): NORMA YACOUB PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NORMA MEKHAIL PSYD

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20241 SW BIRCH ST SUITE 202
NEWPORT BEACH CA
92660-1782
US

IV. Provider business mailing address

20241 SW BIRCH ST SUITE 202
NEWPORT BEACH CA
92660-1782
US

V. Phone/Fax

Practice location:
  • Phone: 949-514-5438
  • Fax:
Mailing address:
  • Phone: 949-514-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY24329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: