Healthcare Provider Details

I. General information

NPI: 1407901341
Provider Name (Legal Business Name): SAIDEH REZAI PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 SOUTH ELENA AVE SUITE C
REDONDO BEACH CA
90277
US

IV. Provider business mailing address

1826 SOUTH ELENA AVE SUITE C
REDONDO BEACH CA
90277
US

V. Phone/Fax

Practice location:
  • Phone: 310-465-0925
  • Fax: 310-541-5136
Mailing address:
  • Phone: 310-465-0925
  • Fax: 310-541-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: