MEDICARE: MINA YADEGAR

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	103TC0700X	Clinical Psychologist	30287	CA

General Provider Information

NPI Number	:	1942796305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA YADEGAR

Provider Business Mailing Address
First Line	:	2632 WILSHIRE BLVD # 731
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 WILSHIRE BLVD # 731
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4623
Country	:	US
Telephone Number	:	323-391-6625
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	10/23/2025

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Directions to “ MINA YADEGAR ” Practice Location

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