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General NPI Number Information
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NPI Number | 1548949977
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Entity Type | Organization
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Legal Business Name | MINOO DARGAH PSY D PSYCHOLOGY INC
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 31 SILVERADO
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City | IRVINE
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State | CA
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Zip | 92618-8888
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Country | US
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Telephone | 949-776-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 4521 CAMPUS DR # 231
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City | IRVINE
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State | CA
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Zip | 92612-2621
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Country | US
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Telephone | 949-776-4004
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MINOO DARGAH
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Credential |
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Telephone | 949-776-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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