Provider Demographics
NPI:1275799298
Name:GONZALEZ, SOHA HEIDARI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SOHA
Middle Name:HEIDARI
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 COCHRAN ST # 1009
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0700
Mailing Address - Country:US
Mailing Address - Phone:818-971-9194
Mailing Address - Fax:855-270-9495
Practice Address - Street 1:2880 COCHRAN ST # 1009
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0700
Practice Address - Country:US
Practice Address - Phone:818-971-9194
Practice Address - Fax:855-270-9495
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27712103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical