Healthcare Provider Details

I. General information

NPI: 1265158067
Provider Name (Legal Business Name): YEROOSHA MEIRZADEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 11/28/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12424 WILSHIRE BLVD STE 650
LOS ANGELES CA
90025-1081
US

IV. Provider business mailing address

5219 NEWCASTLE AVE APT 303
ENCINO CA
91316-4603
US

V. Phone/Fax

Practice location:
  • Phone: 818-277-0268
  • Fax:
Mailing address:
  • Phone: 818-277-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number149843
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: