Doctor Name: | DR. AVID KHORRAM |
NPI Number: | 1043247497 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | PSY14341 |
Business Practice Address: | 701 Garden View Court 20 Encinitas, CA - 92024 |
Business Phone Number: | 7606350044 |
Business Fax Number: | 7606350044 |
Mailing Address: | 701 Garden View Court, 20 ENCINITAS |
State: | CA |
Postal Code: | 92024 |
Phone Number: | 7606350044 |
Fax Number: | 7606350044 |
NPI Enumeration Date: | 06/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY14341 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |