Healthcare Provider Details

I. General information

NPI: 1487631446
Provider Name (Legal Business Name): AHMAD TOUSINEZHAD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 N 8TH ST
FRESNO CA
93720-2262
US

IV. Provider business mailing address

685 W ALLUVIAL AVE STE 103
FRESNO CA
93711-5779
US

V. Phone/Fax

Practice location:
  • Phone: 559-440-0100
  • Fax:
Mailing address:
  • Phone: 559-499-1233
  • Fax: 559-499-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: