Provider Demographics
NPI:1750677324
Name:AMINZADEH AND AHMADPOUR MEDICAL CORPORAITON
Entity Type:Organization
Organization Name:AMINZADEH AND AHMADPOUR MEDICAL CORPORAITON
Other - Org Name:BEHAVIORAL NEUROSCIENCE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-877-0630
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-1890
Mailing Address - Country:US
Mailing Address - Phone:310-691-5005
Mailing Address - Fax:310-691-5236
Practice Address - Street 1:28038 DOROTHY DR STE 200
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4968
Practice Address - Country:US
Practice Address - Phone:310-691-5005
Practice Address - Fax:310-691-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115148207Q00000X
CAA922702084A0401X, 2084P0800X, 2084P0804X
CAA922692084A0401X, 2084P0800X, 2084P0804X
CAA1101132084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty