Basic Information
| Provider Information | |||||||||
| NPI: | 1386760882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEHGHANI | ||||||||
| FirstName: | NEDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3996 GREENWOOD ST | ||||||||
| Address2: | |||||||||
| City: | NEWBURY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913205224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054981726 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6305 WOODMAN AVE | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914012346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189093380 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFI50400 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.