Fazlollah Aldavoud, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 16601 Issued in CA

Practice address

Fifth and Western California Rehabilitation Center
Dept of Corrections State of California
Norco, CA 92860

Phone

(951) 737-2683

Fax

(951) 273-2974

NPI assigned

Jun 6, 2007

Last updated

Jul 25, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1619170958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 TORREYANNA CIRCLE",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928828724",
            "telephone_number": "951-582-0895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FIFTH AND WESTERN CALIFORNIA REHABILITATION CENTER",
            "address_2": "DEPT OF CORRECTIONS STATE OF CALIFORNIA",
            "city": "NORCO",
            "state": "CA",
            "postal_code": "92860",
            "telephone_number": "951-737-2683",
            "fax_number": "951-273-2974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALDAVOUD",
        "first_name": "FAZLOLLAH",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 23813",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "25147",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 16601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xiclaly Diaz Aguilar
• Cassandra Aguirre
• Marieum Ahmad
• Fara Aidul
• Ihab Ahmed Ghalib Al-Jbara
• Ariana Montes Aldon, PPS
• Allcare Family Clinic Inc. (Allcare Family Clinic)
• Rana Alrzoog, DDS
• Armando Altamirano, PMHNP-BC
• Kathleen Altares

• Clinical Psychologist in Norco, CA
• Providers in Norco, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.