Provider Demographics
NPI:1548949977
Name:MINOO DARGAH PSY D PSYCHOLOGY INC
Entity type:Organization
Organization Name:MINOO DARGAH PSY D PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MINOO
Authorized Official - Middle Name:
Authorized Official - Last Name:DARGAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-776-4004
Mailing Address - Street 1:4521 CAMPUS DR # 231
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2621
Mailing Address - Country:US
Mailing Address - Phone:949-776-4004
Mailing Address - Fax:
Practice Address - Street 1:31 SILVERADO
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-8888
Practice Address - Country:US
Practice Address - Phone:949-776-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health