Provider Demographics
NPI:1346786597
Name:TEHRANI, ELAZAR (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELAZAR
Middle Name:
Last Name:TEHRANI
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 1:21621 NORDHOFF ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5825
Mailing Address - Country:US
Mailing Address - Phone:818-439-9848
Mailing Address - Fax:888-539-9697
Practice Address - Street 1:21621 NORDHOFF ST STE 300
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5825
Practice Address - Country:US
Practice Address - Phone:818-439-9848
Practice Address - Fax:888-539-9697
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28780103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA881204Medicaid