Provider Demographics
NPI:1952465049
Name:RAHMAN, ELEANOOR SOHFAM (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:ELEANOOR
Middle Name:SOHFAM
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6765 GOLDY ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9281
Mailing Address - Country:US
Mailing Address - Phone:951-279-0312
Mailing Address - Fax:
Practice Address - Street 1:9990 COUNTY FARM RD STE 6
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3542
Practice Address - Country:US
Practice Address - Phone:951-358-7380
Practice Address - Fax:951-358-7306
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 48839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF 48839OtherMFT INTERN