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NPI Code Detail

MEDICARE: DR. MARJAN MOINZADEH PHD

MEDICARE:  DR. MARJAN  MOINZADEH  PHD
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
1103TC0700XClinical PsychologistPSY18938CA

General Provider Information

NPI Number : 1366540510
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARJAN MOINZADEH PHD
Provider Business Mailing Address
First Line : 2821 CROW CANYON RD STE 202
Second Line :
City : SAN RAMON
State : CA
Zip : 94583-1659
Country : US
Telephone Number : 925-895-2296
Fax Number : 925-837-2191
Provider Business Practice Location Address
First Line : 2821 CROW CANYON RD STE 202
Second Line :
City : SAN RAMON
State : CA
Zip : 94583
Country : US
Telephone Number : 925-895-2296
Fax Number : 925-553-7881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 03/28/2019

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