Healthcare Provider Details

I. General information

NPI: 1841670049
Provider Name (Legal Business Name): MANDANA MOSTOFI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 MERIDIAN AVE APT 313
SAN JOSE CA
95126-3462
US

IV. Provider business mailing address

360 MERIDIAN AVE APT 313
SAN JOSE CA
95126-3462
US

V. Phone/Fax

Practice location:
  • Phone: 650-260-3339
  • Fax:
Mailing address:
  • Phone: 650-260-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY36755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: