Provider Demographics
NPI:1003453804
Name:EMERALD SHORES PSYCHOLOGICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EMERALD SHORES PSYCHOLOGICAL PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:949-231-9968
Mailing Address - Street 1:6230 IRVINE BLVD UNIT 503
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2103
Mailing Address - Country:US
Mailing Address - Phone:949-436-9418
Mailing Address - Fax:
Practice Address - Street 1:27702 RUBIDOUX
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5223
Practice Address - Country:US
Practice Address - Phone:949-231-9968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-30
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty