=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346786597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAZAR TEHRANI PSY.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2017
-----------------------------------------------------
Last Update Date | 02/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21621 NORDHOFF ST STE 300
-----------------------------------------------------
City | CHATSWORTH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91311-5825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-439-9848
-----------------------------------------------------
Fax | 888-539-9697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21621 NORDHOFF ST STE 300
-----------------------------------------------------
City | CHATSWORTH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91311-5825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-439-9848
-----------------------------------------------------
Fax | 888-539-9697
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY28780
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------