Provider Demographics
NPI:1700819174
Name:DOURAGHI, FOROUGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:FOROUGH
Middle Name:
Last Name:DOURAGHI
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 1:5176 AVENIDA PLAYA CANCUN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1534
Mailing Address - Country:US
Mailing Address - Phone:858-567-7323
Mailing Address - Fax:858-268-1069
Practice Address - Street 1:5176 AVENIDA PLAYA CANCUN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1534
Practice Address - Country:US
Practice Address - Phone:858-567-7323
Practice Address - Fax:858-268-1069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14869103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA535285Medicare UPIN