Provider Demographics
NPI:1023398625
Name:MOALI, NAZANIN (MA)
Entity Type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:MOALI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 E. WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PASEDENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104
Mailing Address - Country:US
Mailing Address - Phone:626-797-1161
Mailing Address - Fax:
Practice Address - Street 1:1724 E. WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASEDENA
Practice Address - State:CA
Practice Address - Zip Code:91104
Practice Address - Country:US
Practice Address - Phone:626-797-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program