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NPI Code Detail

MEDICARE: DR. SAMIRA VAFADAR PSYD

MEDICARE:  DR. SAMIRA  VAFADAR  PSYD
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
1103TC0700XClinical PsychologistPSY28213CA

General Provider Information

NPI Number : 1689963514
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMIRA VAFADAR PSYD
Provider Business Mailing Address
First Line : 23 CORPORATE PLAZA DR STE 150
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-7908
Country : US
Telephone Number : 949-329-3733
Fax Number :
Provider Business Practice Location Address
First Line : 23 CORPORATE PLAZA DR STE 150
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-7908
Country : US
Telephone Number : 949-329-3733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2011
Last Update Date : 03/04/2020

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Directions to “ DR. SAMIRA VAFADAR PSYD” Practice Location

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