Provider Demographics
NPI:1558843540
Name:GORJI, TANNAZ
Entity Type:Individual
Prefix:
First Name:TANNAZ
Middle Name:
Last Name:GORJI
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 1:20259 VENTURA BLVD STE 259A
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2551
Mailing Address - Country:US
Mailing Address - Phone:747-249-1127
Mailing Address - Fax:
Practice Address - Street 1:20259 VENTURA BLVD STE 259A
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2551
Practice Address - Country:US
Practice Address - Phone:747-249-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst