Healthcare Provider Details

I. General information

NPI: 1477323954
Provider Name (Legal Business Name): THERAPY BASED PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30101 AGOURA CT STE 204
AGOURA HILLS CA
91301-4341
US

IV. Provider business mailing address

30101 AGOURA CT STE 204
AGOURA HILLS CA
91301-4341
US

V. Phone/Fax

Practice location:
  • Phone: 805-889-0709
  • Fax: 562-261-1098
Mailing address:
  • Phone: 805-889-0709
  • Fax: 562-261-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI NAJAFIAN JAZI
Title or Position: CEO
Credential: MD
Phone: 805-889-0709