Healthcare Provider Details

I. General information

NPI: 1326756875
Provider Name (Legal Business Name): NEDA VAKILI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 5TH AVE
SAN DIEGO CA
92103-5839
US

IV. Provider business mailing address

14318 SPECTRUM
IRVINE CA
92618-3408
US

V. Phone/Fax

Practice location:
  • Phone: 424-388-8088
  • Fax:
Mailing address:
  • Phone: 949-241-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: