Healthcare Provider Details

I. General information

NPI: 1245713163
Provider Name (Legal Business Name): SAIMIR THANO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 STUDENT SERVICES I
IRVINE CA
92697-0001
US

IV. Provider business mailing address

15560 TUSTIN VILLAGE WAY APT 26
TUSTIN CA
92780-4264
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-6457
  • Fax:
Mailing address:
  • Phone: 619-952-3952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: