Provider Demographics
NPI:1932391521
Name:FARHIDAR, MANIJEH
Entity Type:Individual
Prefix:MS
First Name:MANIJEH
Middle Name:
Last Name:FARHIDAR
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 1:3025 BEYER BLVD
Mailing Address - Street 2:SUITE E-102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3432
Mailing Address - Country:US
Mailing Address - Phone:619-428-1000
Mailing Address - Fax:
Practice Address - Street 1:3025 BEYER BLVD
Practice Address - Street 2:SUITE E-102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3432
Practice Address - Country:US
Practice Address - Phone:619-428-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN209711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health