MEDICARE: DR. FOROUGH DOURAGHI 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	103TC1900X	Counseling Psychologist	PSY14869	CA

General Provider Information

NPI Number	:	1700819174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FOROUGH DOURAGHI PH.D

Provider Business Mailing Address
First Line	:	5176 AVENIDA PLAYA CANCUN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1534
Country	:	US
Telephone Number	:	858-567-7323
Fax Number	:	858-268-1069

Provider Business Practice Location Address
First Line	:	5176 AVENIDA PLAYA CANCUN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1534
Country	:	US
Telephone Number	:	858-567-7323
Fax Number	:	858-268-1069

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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