Provider Demographics
NPI:1255594677
Name:KHODAPARAST, NEDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:KHODAPARAST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 BALBOA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6906
Mailing Address - Country:US
Mailing Address - Phone:858-480-9118
Mailing Address - Fax:858-712-9035
Practice Address - Street 1:5252 BALBOA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6906
Practice Address - Country:US
Practice Address - Phone:858-480-9118
Practice Address - Fax:858-712-9035
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X, 103TC1900X
CAPSY23114103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling