Provider Demographics
NPI:1811321193
Name:BAYANI-RAD, NASTARAN (PSYD)
Entity type:Individual
Prefix:
First Name:NASTARAN
Middle Name:
Last Name:BAYANI-RAD
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 1:20929 VENTURA BLVD STE 47-427
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4605 LANKERSHIM BLVD STE 545
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1818
Practice Address - Country:US
Practice Address - Phone:323-999-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2021-06-12
Deactivation Date:2014-12-04
Deactivation Code:
Reactivation Date:2015-05-07
Provider Licenses
StateLicense IDTaxonomies
CAPSY27113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical