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General NPI Number Information
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NPI Number | 1174847529
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Entity Type | Organization
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Legal Business Name | SAN DIEGO PSYCHOLOGICAL & EDCUATION
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 13525 MIDLAND RD., SUITE J
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City | POWAY
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State | CA
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Zip | 92064-4772
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Country | US
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Telephone | 619-789-7173
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Fax |
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Provider Business Mailing Address
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Address Line | 13525 MIDLAND RD., SUITE J
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City | POWAY
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State | CA
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Zip | 92064-4772
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Country | US
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Telephone | 619-789-7173
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYRUS NAKHSHAB
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Credential | PH.D.
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Telephone | 619-789-7173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY15959
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License Number State | CA
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