Provider Demographics
NPI:1619366374
Name:SAMIINIA, FARNOOSH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FARNOOSH
Middle Name:
Last Name:SAMIINIA
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 1:7707 AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95215-8312
Mailing Address - Country:US
Mailing Address - Phone:916-691-0719
Mailing Address - Fax:916-691-0658
Practice Address - Street 1:7707 AUSTIN RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-8312
Practice Address - Country:US
Practice Address - Phone:916-691-0719
Practice Address - Fax:916-691-0658
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical