MEDICARE: NARGES MAHJOUB ESLAMI LMFT

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	251S00000X	Community/Behavioral Health Agency		CA

General Provider Information

NPI Number	:	1528587904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NARGES MAHJOUB ESLAMI LMFT

Provider Business Mailing Address
First Line	:	2101 BUSINESS CENTER DR STE 150
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-1022
Country	:	US
Telephone Number	:	949-502-4721
Fax Number	:

Provider Business Practice Location Address
First Line	:	23331 EL TORO RDE
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-1022
Country	:	US
Telephone Number	:	949-274-3312
Fax Number	:

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

Provider Enumeration Date	:	09/17/2017
Last Update Date	:	09/07/2023

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