Provider Demographics
NPI:1043953730
Name:FARAHYAR, JAMSHID VERIA
Entity Type:Individual
Prefix:
First Name:JAMSHID
Middle Name:VERIA
Last Name:FARAHYAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30101 AGOURA CT STE 111
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4301
Mailing Address - Country:US
Mailing Address - Phone:415-756-1877
Mailing Address - Fax:
Practice Address - Street 1:30101 AGOURA CT STE 111
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4301
Practice Address - Country:US
Practice Address - Phone:415-756-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist