Provider Demographics
NPI:1568538825
Name:FELLEGVARI, IREN (PSYD, MFT, CADCII,)
Entity Type:Individual
Prefix:MS
First Name:IREN
Middle Name:
Last Name:FELLEGVARI
Suffix:
Gender:F
Credentials:PSYD, MFT, CADCII,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 WILSHIRE BLVD 510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3820
Mailing Address - Country:US
Mailing Address - Phone:562-904-3999
Mailing Address - Fax:855-688-8746
Practice Address - Street 1:5230 CARROLL CANYON RD
Practice Address - Street 2:STE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1778
Practice Address - Country:US
Practice Address - Phone:858-353-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46358106H00000X
CARA855007101YA0400X
CA25047103TC0700X
CALR300411101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)