Healthcare Provider Details

I. General information

NPI: 1982532925
Provider Name (Legal Business Name): MYSTIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 WILSHIRE BLVD STE 105
SANTA MONICA CA
90403
US

IV. Provider business mailing address

2901 WILSHIRE BLVD STE 105
SANTA MONICA CA
90403
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-1006
  • Fax: 310-542-7067
Mailing address:
  • Phone: 310-550-1006
  • Fax: 310-542-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. HOUMAN FARZIN
Title or Position: CEO
Credential: MD
Phone: 310-550-1006