Provider Demographics
NPI:1609997709
Name:NIKZAD NEWTON, AZAR (PSYD)
Entity Type:Individual
Prefix:
First Name:AZAR
Middle Name:
Last Name:NIKZAD NEWTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001
Mailing Address - Street 2:KING AVE
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-1210
Mailing Address - Country:US
Mailing Address - Phone:559-992-8800
Mailing Address - Fax:
Practice Address - Street 1:4001 KING AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-9611
Practice Address - Country:US
Practice Address - Phone:559-992-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25144103TC0700X
CAMFT43836106H00000X
CA25144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist