Healthcare Provider Details

I. General information

NPI: 1144799016
Provider Name (Legal Business Name): MICHELLE PEGAH GERAMI AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16516 BERNARDO CENTER DR STE 330
SAN DIEGO CA
92128-2552
US

IV. Provider business mailing address

6055 CAMINO SAN FERMIN UNIT 205
SAN DIEGO CA
92130-6779
US

V. Phone/Fax

Practice location:
  • Phone: 858-333-6856
  • Fax: 858-999-2014
Mailing address:
  • Phone: 858-344-6657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: