MEDICARE: ALI ESFANDIARI PH.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
1	103TC0700X	Clinical Psychologist	0810004318	VA
2	103TC0700X	Clinical Psychologist	PSY30605	CA

General Provider Information

NPI Number	:	1215239603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI ESFANDIARI PH.D.

Provider Business Mailing Address
First Line	:	50 ROSECRANS ST BLDG 500
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-4408
Country	:	US
Telephone Number	:	619-553-0724
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 ROSECRANS ST BLDG 500
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-4408
Country	:	US
Telephone Number	:	619-553-0724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	08/26/2021

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