Provider Demographics
NPI:1790562296
Name:HEZAR, FARIBA
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:HEZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:FAYE
Other - Middle Name:
Other - Last Name:HEZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1451 QUAIL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2747
Mailing Address - Country:US
Mailing Address - Phone:949-679-4000
Mailing Address - Fax:
Practice Address - Street 1:1451 QUAIL ST STE 102
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2747
Practice Address - Country:US
Practice Address - Phone:949-679-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94027820103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist