Provider Demographics
NPI:1447892245
Name:PIRNAZAR, HAYDEH
Entity type:Individual
Prefix:
First Name:HAYDEH
Middle Name:
Last Name:PIRNAZAR
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:PO BOX 4474
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9598
Mailing Address - Country:US
Mailing Address - Phone:310-683-2268
Mailing Address - Fax:
Practice Address - Street 1:1426 AVIATION BLVD STE 103
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4061
Practice Address - Country:US
Practice Address - Phone:310-372-4245
Practice Address - Fax:310-372-2703
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist