Provider Demographics
NPI:1265180350
Name:JALILI, MASOOD
Entity type:Individual
Prefix:
First Name:MASOOD
Middle Name:
Last Name:JALILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16451 E BUENA VISTA AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1861
Mailing Address - Country:US
Mailing Address - Phone:949-545-3120
Mailing Address - Fax:
Practice Address - Street 1:16451 E BUENA VISTA AVE APT 206
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1861
Practice Address - Country:US
Practice Address - Phone:949-545-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician