Provider Demographics
NPI:1477566933
Name:GANDOMI, SOHRAB R (PHD)
Entity Type:Individual
Prefix:
First Name:SOHRAB
Middle Name:R
Last Name:GANDOMI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 S LOUIE LAMOUR DR
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85218-5816
Mailing Address - Country:US
Mailing Address - Phone:480-731-9025
Mailing Address - Fax:480-288-7327
Practice Address - Street 1:1234 S POWER RD
Practice Address - Street 2:SUITE # 207
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3700
Practice Address - Country:US
Practice Address - Phone:480-731-9025
Practice Address - Fax:480-288-7327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCC-0022101YM0800X
AZLMFT-0318106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist