Provider Demographics
NPI:1881268449
Name:PIRALI, IDA
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:PIRALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 NORTHSTAR CV
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-1569
Mailing Address - Country:US
Mailing Address - Phone:310-266-5619
Mailing Address - Fax:
Practice Address - Street 1:2592 NORTHSTAR CV
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-1569
Practice Address - Country:US
Practice Address - Phone:310-266-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist