Provider Demographics
NPI:1376254425
Name:MOHTASHEMI, AVA
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:MOHTASHEMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2697
Mailing Address - Country:US
Mailing Address - Phone:415-279-0005
Mailing Address - Fax:
Practice Address - Street 1:1728 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2697
Practice Address - Country:US
Practice Address - Phone:415-279-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor