Healthcare Provider Details

I. General information

NPI: 1801437389
Provider Name (Legal Business Name): ANAHITA BEHROUZI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

PO BOX 1852
ORANGEVALE CA
95662-1852
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7143
  • Fax:
Mailing address:
  • Phone: 916-545-5078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021437
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95056420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: