Provider Demographics
NPI:1902367758
Name:MONTAZERIAN, SABA (MA)
Entity Type:Individual
Prefix:
First Name:SABA
Middle Name:
Last Name:MONTAZERIAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 QUAIL ST STE 206
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2782
Mailing Address - Country:US
Mailing Address - Phone:949-229-0567
Mailing Address - Fax:
Practice Address - Street 1:1100 QUAIL ST STE 206
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2782
Practice Address - Country:US
Practice Address - Phone:949-229-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001268106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist