Provider Demographics
NPI:1184970808
Name:TAMJIDI, DESIREE (PHD)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:TAMJIDI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14622 VENTURA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3662
Mailing Address - Country:US
Mailing Address - Phone:661-469-1545
Mailing Address - Fax:
Practice Address - Street 1:16200 VENTURA BLVD STE 403
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4692
Practice Address - Country:US
Practice Address - Phone:661-469-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical