Provider Demographics
NPI:1528596996
Name:SOHRABPARTOVI, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SOHRABPARTOVI
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 1:14717 HAWTHORNE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1580
Mailing Address - Country:US
Mailing Address - Phone:310-355-0432
Mailing Address - Fax:
Practice Address - Street 1:14717 HAWTHORNE BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1580
Practice Address - Country:US
Practice Address - Phone:310-355-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF93900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist