Provider Demographics
NPI:1134279730
Name:GHODS, NILOOFAR (MS)
Entity Type:Individual
Prefix:
First Name:NILOOFAR
Middle Name:
Last Name:GHODS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17411 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6763
Mailing Address - Country:US
Mailing Address - Phone:619-865-7999
Mailing Address - Fax:
Practice Address - Street 1:17411 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-6763
Practice Address - Country:US
Practice Address - Phone:619-865-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health