Provider Demographics
NPI:1033299540
Name:BEHBEHANI, SORAYA SUSAN
Entity Type:Individual
Prefix:MS
First Name:SORAYA
Middle Name:SUSAN
Last Name:BEHBEHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 OBERLIN DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4719
Mailing Address - Country:US
Mailing Address - Phone:619-920-8892
Mailing Address - Fax:858-638-1957
Practice Address - Street 1:5850 OBERLIN DR
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4719
Practice Address - Country:US
Practice Address - Phone:619-920-8892
Practice Address - Fax:858-638-1957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT37836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA018564-01Medicaid