Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 28959 | CA |
Y | 103T00000X | Psychologist | 28959 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1285004036 |
---|---|
Provider Name | Annie Gharakhani |
First Address | Montrose, CA 91020-1604 |
Second Address | Montrose, CA 91020-1604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 08/02/2017 |