Provider Demographics
NPI:1558922427
Name:HADDADZADEH, ROYA (DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:ROYA
Middle Name:
Last Name:HADDADZADEH
Suffix:
Gender:F
Credentials:DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 HARBOR BLVD. SUITE B8
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5212
Mailing Address - Country:US
Mailing Address - Phone:714-786-6069
Mailing Address - Fax:
Practice Address - Street 1:3303 HARBOR BLVD. SUITE B8
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5212
Practice Address - Country:US
Practice Address - Phone:714-786-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst