Healthcare Provider Details

I. General information

NPI: 1992910046
Provider Name (Legal Business Name): MOJGAN JELVEH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 VAN NESS AVE FL 3
SAN FRANCISCO CA
94109-3608
US

IV. Provider business mailing address

407 PENNSYLVANIA AVE
SAN FRANCISCO CA
94107-2911
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-2293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number19925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: