Healthcare Provider Details

I. General information

NPI: 1962962100
Provider Name (Legal Business Name): AMIR VAHABINEJAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MISSION CENTER RD STE 105
SAN DIEGO CA
92108-1347
US

IV. Provider business mailing address

1202 MORENA BLVD STE 300
SAN DIEGO CA
92110-3844
US

V. Phone/Fax

Practice location:
  • Phone: 224-548-6815
  • Fax:
Mailing address:
  • Phone: 619-275-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: