Provider Demographics
NPI:1518454131
Name:SOROURI, FERESHTEH GHAHREMANI
Entity Type:Individual
Prefix:
First Name:FERESHTEH
Middle Name:GHAHREMANI
Last Name:SOROURI
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 1:14252 CULVER DR # 353
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0317
Mailing Address - Country:US
Mailing Address - Phone:949-910-6219
Mailing Address - Fax:
Practice Address - Street 1:4929 WILSHIRE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3820
Practice Address - Country:US
Practice Address - Phone:888-307-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist