Provider Demographics
NPI:1033545801
Name:ECKFELD, ARIEL (PHD)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:ECKFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 S EVENINGSONG LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1616
Mailing Address - Country:US
Mailing Address - Phone:973-951-6940
Mailing Address - Fax:
Practice Address - Street 1:1550 BAYSIDE DR STE 2
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1711
Practice Address - Country:US
Practice Address - Phone:949-783-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30913103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty