MEDICARE: DORNA KHAFAJIZAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist	LMFT160533	CA
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1093228421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORNA KHAFAJIZAD

Provider Business Mailing Address
First Line	:	30941 AGOURA RD STE 210
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4658
Country	:	US
Telephone Number	:	805-272-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	30941 AGOURA RD STE 210
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4658
Country	:	US
Telephone Number	:	805-272-0077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	01/05/2026

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