Provider Demographics
NPI:1194023994
Name:IZADI, AFSHEEN
Entity type:Individual
Prefix:
First Name:AFSHEEN
Middle Name:
Last Name:IZADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:IZADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:38713 TIERRA SUBIDA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4562
Mailing Address - Country:US
Mailing Address - Phone:661-583-3142
Mailing Address - Fax:661-793-7392
Practice Address - Street 1:3446 SONYA AVE
Practice Address - Street 2:
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560-6831
Practice Address - Country:US
Practice Address - Phone:661-583-3142
Practice Address - Fax:661-793-7392
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134295106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist