Provider Demographics
NPI:1770148694
Name:NEGAR NAZARI PHD PSYCHOLOGIST INC
Entity type:Organization
Organization Name:NEGAR NAZARI PHD PSYCHOLOGIST INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-483-1427
Mailing Address - Street 1:9450 MIRA MESA BLVD # C676
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4801
Mailing Address - Country:US
Mailing Address - Phone:619-483-1427
Mailing Address - Fax:
Practice Address - Street 1:3636 4TH AVE STE 304
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4294
Practice Address - Country:US
Practice Address - Phone:858-481-8827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063854099Medicaid