Provider Demographics
NPI:1124862115
Name:FARSHIDFARD, MOSTAFA (PSYD)
Entity type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:
Last Name:FARSHIDFARD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TALISMAN
Mailing Address - Street 2:APT 736
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620
Mailing Address - Country:US
Mailing Address - Phone:949-701-6702
Mailing Address - Fax:949-481-1149
Practice Address - Street 1:30290 RANCHO VIEJO RD
Practice Address - Street 2:104
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-933-3556
Practice Address - Fax:949-481-1149
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health