Healthcare Provider Details

I. General information

NPI: 1497132260
Provider Name (Legal Business Name): HEDIEH AZADMEHR PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HIGH BLUFF DR STE 103
SAN DIEGO CA
92130-2053
US

IV. Provider business mailing address

12625 HIGH BLUFF DR STE 103
SAN DIEGO CA
92130-2053
US

V. Phone/Fax

Practice location:
  • Phone: 858-877-1860
  • Fax: 855-554-1110
Mailing address:
  • Phone: 858-877-1860
  • Fax: 855-554-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY28899
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: