Provider Demographics
NPI:1659902146
Name:MAZDIYASSNI, ANAHITA
Entity Type:Individual
Prefix:
First Name:ANAHITA
Middle Name:
Last Name:MAZDIYASSNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16772 LITTLEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5634
Mailing Address - Country:US
Mailing Address - Phone:408-896-9064
Mailing Address - Fax:
Practice Address - Street 1:6529 CROWN BLVD STE D
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2905
Practice Address - Country:US
Practice Address - Phone:408-896-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical