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NPI Code Detail

MEDICARE: SOSEH ESMAEILI M.A., PSY.D.

MEDICARE: SOSEH ESMAEILI M.A., PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY25927CA
2103T00000XPsychologistPY0778NV

General Provider Information

NPI Number : 1194974618
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOSEH ESMAEILI M.A., PSY.D.
Provider Business Mailing Address
First Line : 2620 REGATTA DR STE 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-6892
Country : US
Telephone Number : 702-553-2364
Fax Number :
Provider Business Practice Location Address
First Line : 2620 REGATTA DR STE 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-6892
Country : US
Telephone Number : 702-553-2364
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2008
Last Update Date : 11/25/2016

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