Provider Demographics
NPI:1336827765
Name:NEJAD, HANIEH
Entity Type:Individual
Prefix:
First Name:HANIEH
Middle Name:
Last Name:NEJAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANIEH
Other - Middle Name:
Other - Last Name:BIDOKHTINEJAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19355 SHERMAN WAY UNIT 38
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3566
Mailing Address - Country:US
Mailing Address - Phone:818-264-8263
Mailing Address - Fax:
Practice Address - Street 1:19355 SHERMAN WAY UNIT 38
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3566
Practice Address - Country:US
Practice Address - Phone:818-264-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95073984163WP0808X
CA95025639363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health