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901 Dove St Ste 150 Newport Beach CA 92660-3018 | |
| (949) 701-7976 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 901 Dove St Ste 150, Newport Beach, California |
| Authorized Official Name and Position | Dimitra Takos (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9497017976 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
901 Dove St Ste 150 Newport Beach CA 92660-3018 Ph: (949) 701-7976 | 901 Dove St Ste 150 Newport Beach CA 92660-3018 Ph: (949) 701-7976 |
| NPI Number | 1285154450 |
|---|---|
| Provider Enumeration Date | 06/20/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285154450 | NPI | - | NPPES |
| 1982841953 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 21903 (California) | Primary |
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