Provider Demographics
NPI:1194023994
Name:IZADI, AFSHEEN
Entity Type:Individual
Prefix:
First Name:AFSHEEN
Middle Name:
Last Name:IZADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:IZADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:32297 BIG OAK LN
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-4124
Mailing Address - Country:US
Mailing Address - Phone:626-277-1307
Mailing Address - Fax:
Practice Address - Street 1:9517 REA AVE
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-4831
Practice Address - Country:US
Practice Address - Phone:626-277-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134295106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist