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NPI Code Detail

MEDICARE: MS. AZADEH GOLSHANI M.S.

MEDICARE: MS. AZADEH GOLSHANI M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY28464CA

General Provider Information

NPI Number : 1093064420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AZADEH GOLSHANI M.S.
Provider Business Mailing Address
First Line : 711 S NEW HAMPSHIRE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90005-1831
Country : US
Telephone Number : 213-385-5100
Fax Number :
Provider Business Practice Location Address
First Line : 4300 LONG BEACH BLVD STE 700
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-2000
Country : US
Telephone Number : 213-385-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2012
Last Update Date : 02/15/2017

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