Healthcare Provider Details

I. General information

NPI: 1013491034
Provider Name (Legal Business Name): FATHIEH IRANNEJAD ETC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 SKYPARK DR STE 215
TORRANCE CA
90505-5388
US

IV. Provider business mailing address

2790 SKYPARK DR STE 215
TORRANCE CA
90505-5388
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-3990
  • Fax:
Mailing address:
  • Phone: 310-753-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: