Provider Demographics
NPI:1255209987
Name:TAHERIZADEGAN, ZAHRA
Entity type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:TAHERIZADEGAN
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 1:19751 LOMBARDY LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2818
Mailing Address - Country:US
Mailing Address - Phone:949-678-4961
Mailing Address - Fax:
Practice Address - Street 1:23986 ALISO CREEK RD # 761
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3908
Practice Address - Country:US
Practice Address - Phone:949-633-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty