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General NPI Number Information
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NPI Number | 1912041484
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Entity Type | Individual
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Provider Name | FARIBA KEZEL PHD
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Gender | Female
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 4199 CAMPUS DR SUITE 550
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City | IRVINE
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State | CA
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Zip | 92612-4696
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Country | US
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Telephone | 714-490-4965
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Fax | 949-509-6599
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Provider Business Mailing Address
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Address Line | 4199 CAMPUS DR SUITE 550
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City | IRVINE
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State | CA
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Zip | 92612-4696
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Country | US
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Telephone | 714-490-4965
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Fax | 949-509-6599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY20295
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY20295
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY20295
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License Number State | CA
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