Provider Demographics
NPI:1952555112
Name:HEDAYATI, FARZANEH
Entity Type:Individual
Prefix:MISS
First Name:FARZANEH
Middle Name:
Last Name:HEDAYATI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:FARRAH
Other - Middle Name:
Other - Last Name:HEDAYATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20172 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0737
Mailing Address - Country:US
Mailing Address - Phone:714-595-6029
Mailing Address - Fax:
Practice Address - Street 1:14351 RED HILL AVE STE C
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6271
Practice Address - Country:US
Practice Address - Phone:714-595-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist