Provider Demographics
NPI:1992212278
Name:TALEBIZADEH, MARJAN
Entity Type:Individual
Prefix:
First Name:MARJAN
Middle Name:
Last Name:TALEBIZADEH
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 1:26441 CROWN VALLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8529
Mailing Address - Country:US
Mailing Address - Phone:949-791-7471
Mailing Address - Fax:
Practice Address - Street 1:26441 CROWN VALLEY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8529
Practice Address - Country:US
Practice Address - Phone:949-791-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF78925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health