Healthcare Provider Details

I. General information

NPI: 1588813380
Provider Name (Legal Business Name): DR. GOLNOUSH MONFARED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 NW AMBERGLEN PKWY SUITE 400
BEAVERTON OR
97006-6951
US

IV. Provider business mailing address

1915 NW AMBERGLEN PKWY SUITE 400
BEAVERTON OR
97006-6951
US

V. Phone/Fax

Practice location:
  • Phone: 408-418-6019
  • Fax:
Mailing address:
  • Phone: 408-418-6019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2712
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number27379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: