Provider Demographics
NPI:1053336982
Name:KHODADOOST-DEHGHI, FARNAZ (PHD)
Entity type:Individual
Prefix:DR
First Name:FARNAZ
Middle Name:
Last Name:KHODADOOST-DEHGHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 S HARBOR BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7534
Mailing Address - Country:US
Mailing Address - Phone:714-653-8805
Mailing Address - Fax:714-447-9386
Practice Address - Street 1:1480 S HARBOR BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7534
Practice Address - Country:US
Practice Address - Phone:714-653-8805
Practice Address - Fax:714-447-9386
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17403103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist