Healthcare Provider Details

I. General information

NPI: 1881319937
Provider Name (Legal Business Name): ANAHITA JANNESARI MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 4TH AVE
SAN DIEGO CA
92101-2394
US

IV. Provider business mailing address

3405 KENYON ST STE 202
SAN DIEGO CA
92110-5005
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-3432
  • Fax:
Mailing address:
  • Phone: 858-598-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY94028767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: