Provider Demographics
NPI:1487631446
Name:TOUSINEZHAD, AHMAD (PHD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:TOUSINEZHAD
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 1:8140 N 8TH ST
Mailing Address - Street 2:P O BOX 25125
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2262
Mailing Address - Country:US
Mailing Address - Phone:559-440-0100
Mailing Address - Fax:
Practice Address - Street 1:8140 N 8TH ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2262
Practice Address - Country:US
Practice Address - Phone:559-440-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY15544Medicaid
CAPSY15544Medicaid