Doctor Name: | DR. FARZANEH EHSAN |
NPI Number: | 1144647819 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | 28121 |
Business Practice Address: | 12821 Victory Blvd N Hollywood, CA - 916063012 |
Business Phone Number: | 3108770600 |
Business Fax Number: | |
Mailing Address: | 3112 Corda Dr, LOS ANGELES |
State: | CA |
Postal Code: | 900491104 |
Phone Number: | 3108770600 |
Fax Number: | |
NPI Enumeration Date: | 03/19/2014 |
NPI Last Update Date: | 03/20/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 28121 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |