Provider Demographics
NPI:1558804450
Name:MALAKOUTI-NEJAD, NAYSAN
Entity Type:Individual
Prefix:
First Name:NAYSAN
Middle Name:
Last Name:MALAKOUTI-NEJAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23901 CALABASAS RD STE 1076
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1581
Mailing Address - Country:US
Mailing Address - Phone:424-354-9287
Mailing Address - Fax:
Practice Address - Street 1:23901 CALABASAS RD STE 1076
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1581
Practice Address - Country:US
Practice Address - Phone:424-354-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY33391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program