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General NPI Number Information
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NPI Number | 1033620711
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Entity Type | Organization
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Legal Business Name | DR. JALALI AND ASSOCIATES
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 180 NEWPORT CENTER DR STE 270D
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-6972
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Country | US
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Telephone | 310-849-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 3395 MICHELSON DR APT 5211
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City | IRVINE
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State | CA
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Zip | 92612-3435
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Country | US
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Telephone | 310-849-0801
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/PRESIDENT
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Name | DR. SHAHRZAD JALALI BIDGOLI
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Credential | PYSD
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Telephone | 310-849-0801
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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 | 27593
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License Number State | CA
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