Provider Demographics
NPI:1053742767
Name:HAYDERZADEH, ZAHRA
Entity type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:HAYDERZADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZAHRA
Other - Middle Name:
Other - Last Name:AHMADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2913 EL CAMINO REAL # 128
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4281 KATELLA AVE STE 226
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6504
Practice Address - Country:US
Practice Address - Phone:714-455-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT98368106H00000X
CALMFT127543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist