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NPI Code Detail

MEDICARE: DR. AVID G FARAHANI PSYD

MEDICARE: DR. AVID G FARAHANI PSYD
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 PsychologistPSY23456CA
2103TC0700XClinical Psychologist2166OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558515338
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AVID G FARAHANI PSYD
Provider Business Mailing Address
First Line : 18946 TUBA ST
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91324-1230
Country : US
Telephone Number : 503-575-1317
Fax Number : 503-388-4144
Provider Business Practice Location Address
First Line : 10260 SW GREENBURG RD STE 400
Second Line :
City : PORTLAND
State : OR
Zip : 97223-5514
Country : US
Telephone Number : 503-575-1317
Fax Number : 503-388-4144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2008
Last Update Date : 05/23/2022

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