Provider Demographics
NPI:1568655728
Name:ESFAHANI, MARIAM ESHGHI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:ESHGHI
Last Name:ESFAHANI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:MARIAM
Other - Middle Name:
Other - Last Name:GHANAVATZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:15596 PRODUCER LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1308
Mailing Address - Country:US
Mailing Address - Phone:714-891-6133
Mailing Address - Fax:
Practice Address - Street 1:15596 PRODUCER LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1308
Practice Address - Country:US
Practice Address - Phone:714-891-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist