Healthcare Provider Details

I. General information

NPI: 1477314292
Provider Name (Legal Business Name): FARNAZ KHOROMI PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 OBERLIN DR STE 330
SAN DIEGO CA
92121-4747
US

IV. Provider business mailing address

5850 OBERLIN DR STE 330
SAN DIEGO CA
92121-4747
US

V. Phone/Fax

Practice location:
  • Phone: 858-449-0887
  • Fax:
Mailing address:
  • Phone: 858-449-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number27479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: