Basic Information
| Provider Information | |||||||||
| NPI: | 1033620711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. JALALI AND ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3395 MICHELSON DR APT 5211 | ||||||||
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| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926123435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108490801 | ||||||||
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| Practice Location | |||||||||
| Address1: | 180 NEWPORT CENTER DR STE 270D | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926606972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108490801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2017 | ||||||||
| LastUpdateDate: | 10/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | JALALI BIDGOLI | ||||||||
| AuthorizedOfficialFirstName: | SHAHRZAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3108490801 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PYSD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 27593 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.