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NPI Code Detail

MEDICARE: AZADEH FAMILI PH.D.

MEDICARE:   AZADEH  FAMILI  PH.D.
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
1103TA0400XAddiction (Substance Use Disorder) PsychologistPSY16456CA
2103TB0200XCognitive & Behavioral PsychologistPSY16456CA
3103TF0200XForensic PsychologistPSY16456CA

General Provider Information

NPI Number : 1639429996
Entity Type Code : Individual
Provider Name (Legal Business Name) : AZADEH FAMILI PH.D.
Provider Business Mailing Address
First Line : 150 E MEDA AVE STE 110
Second Line :
City : GLENDORA
State : CA
Zip : 91741-2607
Country : US
Telephone Number : 626-253-3149
Fax Number : 626-857-9092
Provider Business Practice Location Address
First Line : 150 E MEDA AVE STE 110
Second Line :
City : GLENDORA
State : CA
Zip : 91741-2607
Country : US
Telephone Number : 626-253-3149
Fax Number : 626-857-9092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2012
Last Update Date : 09/13/2012

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Directions to “ AZADEH FAMILI PH.D.” Practice Location

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