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General NPI Number Information
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NPI Number | 1003453804
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Entity Type | Organization
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Legal Business Name | EMERALD SHORES PSYCHOLOGICAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/30/2019
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Last Update Date | 08/17/2024
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Provider Practice Location Address
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Address Line | 27702 RUBIDOUX
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City | MISSION VIEJO
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State | CA
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Zip | 92692-5223
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Country | US
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Telephone | 949-231-9968
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Fax |
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Provider Business Mailing Address
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Address Line | 6230 IRVINE BLVD UNIT 503
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City | IRVINE
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State | CA
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Zip | 92620-2103
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Country | US
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Telephone | 949-436-9418
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. PAYAM JAFARI
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Credential | ED.D.
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Telephone | 949-231-9968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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