Provider Demographics
NPI:1639448103
Name:MOHADJER, CAMELLIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMELLIA
Middle Name:
Last Name:MOHADJER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAMELIA
Other - Middle Name:
Other - Last Name:FARID-MOHAJER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28772 TOMELLOSO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1090
Mailing Address - Country:US
Mailing Address - Phone:949-726-2264
Mailing Address - Fax:
Practice Address - Street 1:701 SCOFIELD AVE
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-7515
Practice Address - Country:US
Practice Address - Phone:661-758-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24624103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic