Healthcare Provider Details

I. General information

NPI: 1194289868
Provider Name (Legal Business Name): FARHAD NIKOO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23832 ROCKFIELD BLVD STE 120
LAKE FOREST CA
92630-2870
US

IV. Provider business mailing address

23832 ROCKFIELD BLVD STE 120
LAKE FOREST CA
92630-2870
US

V. Phone/Fax

Practice location:
  • Phone: 714-769-6090
  • Fax:
Mailing address:
  • Phone: 714-769-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: FARHAD GHASEMI NIKOO
Title or Position: PMHNP
Credential:
Phone: 714-769-6090