Healthcare Provider Details

I. General information

NPI: 1972468619
Provider Name (Legal Business Name): AMIR JAHANGARD MAHBOOB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18226 VENTURA BLVD STE 202
TARZANA CA
91356-4246
US

IV. Provider business mailing address

18226 VENTURA BLVD STE 202
TARZANA CA
91356-4246
US

V. Phone/Fax

Practice location:
  • Phone: 818-975-8097
  • Fax:
Mailing address:
  • Phone: 818-652-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: