Healthcare Provider Details

I. General information

NPI: 1407630346
Provider Name (Legal Business Name): MS. FARNAZ KAZI MOHIUDDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 POTRERO AVE
SAN FRANCISCO CA
94110-2859
US

IV. Provider business mailing address

601 VAN NESS AVE # E3-234
SAN FRANCISCO CA
94102-3200
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-5252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number151966
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: