Healthcare Provider Details

I. General information

NPI: 1912313065
Provider Name (Legal Business Name): SEPIDA SAZGAR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S MADISON AVE APT 6
PASADENA CA
91101-2574
US

IV. Provider business mailing address

180 S MADISON AVE APT 6
PASADENA CA
91101-2574
US

V. Phone/Fax

Practice location:
  • Phone: 747-200-5367
  • Fax:
Mailing address:
  • Phone: 747-200-5367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: