NPI Code Detail JSON Logo

1619170958 NPI number — FAZLOLLAH ALDAVOUD PHD

NPI Number: 1619170958
Health Care Provider/Practitioner: FAZLOLLAH ALDAVOUD PHD

Information about “1619170958” NPI (FAZLOLLAH ALDAVOUD PHD) exists in 1619170958 in HTML format HTML  |  1619170958 in plain Text format TXT  |  1619170958 in PDF (Portable Document Format) PDF  |  1619170958 in an XML format XML  formats.

NPI Number : 1619170958 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619170958",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ALDAVOUD",
    "FirstName": "FAZLOLLAH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1460 TORREYANNA CIRCLE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CORONA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92882-8724",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-582-0895",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "FIFTH AND WESTERN CALIFORNIA REHABILITATION CENTER",
    "SecondLinePracticeLocationAddress": "DEPT OF CORRECTIONS STATE OF CALIFORNIA",
    "PracticeLocationAddressCityName": "NORCO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92860",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-737-2683",
    "PracticeLocationAddressFaxNumber": "951-273-2974",
    "EnumerationDate": "06/06/2007",
    "LastUpdateDate": "07/25/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "MFC 23813",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "25147",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PSY 16601",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.