Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY22915 | CA |
Y | 103T00000X | Psychologist | PSY22915 | CA |
NPI | 1003946179 |
---|---|
Provider Name | Dr. Pardis Amirhoushmand |
First Address | Ontario, CA 91762-3205 |
Second Address | Ontario, CA 91762-3205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 25/07/2019 |