Healthcare Provider Details

I. General information

NPI: 1891670147
Provider Name (Legal Business Name): AMIR FAAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28649 S WESTERN AVE UNIT 6764
SAN PEDRO CA
90734-0113
US

IV. Provider business mailing address

28649 S WESTERN AVE UNIT 6764
SAN PEDRO CA
90734-0113
US

V. Phone/Fax

Practice location:
  • Phone: 877-613-3768
  • Fax:
Mailing address:
  • Phone: 877-613-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: