Provider Demographics
NPI:1477876753
Name:BABAI SIAHDOHONI, NADER (PHD)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:BABAI SIAHDOHONI
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 1:3151 AIRWAY AVE STE D2
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4622
Mailing Address - Country:US
Mailing Address - Phone:949-769-1372
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE D2
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4622
Practice Address - Country:US
Practice Address - Phone:949-769-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4419103TC0700X
CAPSY28098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical