Healthcare Provider Details

I. General information

NPI: 1326756875
Provider Name (Legal Business Name): NEDA VAKILI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 E CHEVY CHASE DR
GLENDALE CA
91206-4172
US

IV. Provider business mailing address

1577 E CHEVY CHASE DR STE 120
GLENDALE CA
91206-4193
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY36443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: