Healthcare Provider Details

I. General information

NPI: 1902632540
Provider Name (Legal Business Name): QAZIZADA MULTICULTURAL THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 N SANTIAGO BLVD STE 200
ORANGE CA
92867-1700
US

IV. Provider business mailing address

2854 N SANTIAGO BLVD STE 200
ORANGE CA
92867-1700
US

V. Phone/Fax

Practice location:
  • Phone: 310-985-3845
  • Fax:
Mailing address:
  • Phone: 310-985-3845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: WALI ABDUL HANIFZAI
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 310-985-3845