Basic Information
| Provider Information | |||||||||
| NPI: | 1821336843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOSSEINZADEH | ||||||||
| FirstName: | NAHAL | ||||||||
| MiddleName: | KASHANI | ||||||||
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| Credential: | M.A., B.C.B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19019 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913563253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183452345 | ||||||||
| FaxNumber: | 8665872383 | ||||||||
| Practice Location | |||||||||
| Address1: | 12399 LEWIS ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928404697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147500575 | ||||||||
| FaxNumber: | 7147500160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2013 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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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 | 103K00000X | 1-12-12429 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.