Provider Demographics
NPI:1336109032
Name:NAKHSHAB, CYRUS (PHD EDD)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:
Last Name:NAKHSHAB
Suffix:
Gender:M
Credentials:PHD EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13525 MIDLAND ROAD
Mailing Address - Street 2:SUITE J
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064
Mailing Address - Country:US
Mailing Address - Phone:760-519-2510
Mailing Address - Fax:760-230-1450
Practice Address - Street 1:13525 MIDLAND ROAD
Practice Address - Street 2:SUITE J
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92065
Practice Address - Country:US
Practice Address - Phone:760-519-2510
Practice Address - Fax:760-230-1450
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PSY15959103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP15959Medicare ID - Type Unspecified
S74895Medicare UPIN