=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538574645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZOHREH KERMANI PSY.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2014
-----------------------------------------------------
Last Update Date | 09/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1350 COLUMBIA ST UNIT 800
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-259-3030
-----------------------------------------------------
Fax | 619-942-5048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1350 COLUMBIA ST UNIT 800
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-771-4388
-----------------------------------------------------
Fax | 619-942-5048
-----------------------------------------------------
=====================================================
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 | PSY32653
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------