Individual
FAZLOLLAH ALDAVOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
FIFTH AND WESTERN CALIFORNIA REHABILITATION CENTER, DEPT OF CORRECTIONS STATE OF CALIFORNIA, NORCO, CA 92860
(951) 737-2683
(951) 273-2974
Mailing address
1460 TORREYANNA CIRCLE, CORONA, CA 92882-8724
(951) 582-0895
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 16601
CA
106H00000X
Marriage & Family Therapist
MFC 23813
CA
174400000X
Specialist
25147
CA
Other
Enumeration date
06/06/2007
Last updated
07/25/2022
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