Provider Demographics
NPI:1477314292
Name:KHOROMI, FARNAZ (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:FARNAZ
Middle Name:
Last Name:KHOROMI
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 OBERLIN DR STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4747
Mailing Address - Country:US
Mailing Address - Phone:858-449-0887
Mailing Address - Fax:
Practice Address - Street 1:5850 OBERLIN DR STE 330
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4747
Practice Address - Country:US
Practice Address - Phone:858-449-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27479103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist