Provider Demographics
NPI:1699377606
Name:KARANDISH, MAZYAR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAZYAR
Middle Name:
Last Name:KARANDISH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11162 MAYS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9553
Mailing Address - Country:US
Mailing Address - Phone:949-302-3867
Mailing Address - Fax:
Practice Address - Street 1:19375 HWY 116
Practice Address - Street 2:
Practice Address - City:MONTE RIO
Practice Address - State:CA
Practice Address - Zip Code:95462
Practice Address - Country:US
Practice Address - Phone:707-865-1200
Practice Address - Fax:707-865-5122
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94024924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical