Provider Demographics
NPI:1003946179
Name:AMIRHOUSHMAND, PARDIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PARDIS
Middle Name:
Last Name:AMIRHOUSHMAND
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 1:317 W F ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3205
Mailing Address - Country:US
Mailing Address - Phone:714-325-5621
Mailing Address - Fax:909-391-3068
Practice Address - Street 1:317 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3205
Practice Address - Country:US
Practice Address - Phone:909-391-3051
Practice Address - Fax:909-391-3068
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22915103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPTAN: CE817AMedicare PIN