Healthcare Provider Details

I. General information

NPI: 1295022697
Provider Name (Legal Business Name): MS. ARTMIZ BAHADORI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 15TH ST UNIT 508
SAN DIEGO CA
92101-7577
US

IV. Provider business mailing address

1041 MARKET ST # 206
SAN DIEGO CA
92101-7233
US

V. Phone/Fax

Practice location:
  • Phone: 619-535-1678
  • Fax:
Mailing address:
  • Phone: 619-535-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number116205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: