Healthcare Provider Details

I. General information

NPI: 1427154038
Provider Name (Legal Business Name): DARYOUSH JAMAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 E DEL MAR BLVD SUITE 14
PASADENA CA
91107-4321
US

IV. Provider business mailing address

2810 E DEL MAR BLVD SUITE 14
PASADENA CA
91107-4321
US

V. Phone/Fax

Practice location:
  • Phone: 626-437-1000
  • Fax: 866-412-0243
Mailing address:
  • Phone: 626-437-1000
  • Fax: 866-412-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA85105
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA85105
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA85105
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA85105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: