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General NPI Number Information
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NPI Number | 1841180916
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Entity Type | Individual
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Provider Name | NINA FAROKHZAD
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Gender |
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 633 W 5TH ST FL 26
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City | LOS ANGELES
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State | CA
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Zip | 90071-2053
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Country | US
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Telephone | 213-612-7777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 351853
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City | LOS ANGELES
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State | CA
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Zip | 90035-8842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PSY25686
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License Number State | CA
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