| None | |
|
13525 Midland Rd Suite J Poway CA 92064-4771 | |
| (760) 789-7173 | |
| (760) 230-1450 |
| Full Name | None |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 13525 Midland Rd, Poway, California |
| Authorized Official Name and Position | Cyrus Nakhshab (OWNER) |
| Authorized Official Contact | 7605192510 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 13525 Midland Rd Ste J Poway CA 92064-4772 Ph: (760) 519-2510 | None 13525 Midland Rd Suite J Poway CA 92064-4771 Ph: (760) 789-7173 |
| NPI Number | 1548520471 |
|---|---|
| Provider Enumeration Date | 05/25/2012 |
| Last Update Date | 05/25/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548520471 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY15959 (California) | Primary |
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