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General NPI Number Information
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NPI Number | 1518837939
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Entity Type | Organization
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Legal Business Name | MEDISA PAYVARPOUR PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 1398 SOLANO AVE STE 7
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City | ALBANY
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State | CA
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Zip | 94706-1855
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Country | US
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Telephone | 510-605-0688
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Fax |
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Provider Business Mailing Address
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Address Line | 1398 SOLANO AVE STE 7
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City | ALBANY
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State | CA
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Zip | 94706-1855
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Country | US
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Telephone | 510-605-0688
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEDISA PAYVARPOUR
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Credential | PSYD
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Telephone | 510-206-6641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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