Healthcare Provider Details

I. General information

NPI: 1972829711
Provider Name (Legal Business Name): BEHROUZ NAMDARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N EUCLID ST
ANAHEIM CA
92801-1900
US

IV. Provider business mailing address

1188 N EUCLID ST
ANAHEIM CA
92801-1900
US

V. Phone/Fax

Practice location:
  • Phone: 714-223-2600
  • Fax:
Mailing address:
  • Phone: 714-223-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number141707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: