Healthcare Provider Details

I. General information

NPI: 1629717277
Provider Name (Legal Business Name): AZADEH KHAMOOSHI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AVA KHAMOOSHI DR.

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17702 SIERRA HWY
SANTA CLARITA CA
91351-1635
US

IV. Provider business mailing address

4445 EASTGATE MALL # 2073
SAN DIEGO CA
92121-1979
US

V. Phone/Fax

Practice location:
  • Phone: 888-770-5222
  • Fax:
Mailing address:
  • Phone: 619-212-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94028153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: