Healthcare Provider Details

I. General information

NPI: 1770148694
Provider Name (Legal Business Name): NEGAR NAZARI PHD PSYCHOLOGIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 4TH AVE STE 304
SAN DIEGO CA
92103-4294
US

IV. Provider business mailing address

9450 MIRA MESA BLVD # C676
SAN DIEGO CA
92126-4801
US

V. Phone/Fax

Practice location:
  • Phone: 858-481-8827
  • Fax:
Mailing address:
  • Phone: 619-483-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NEGAR NAZARI
Title or Position: INDEPENDENT PRACTITIONER
Credential: PH.D.
Phone: 619-483-1427