Provider Demographics
NPI:1427661370
Name:NOURI, PARVA
Entity type:Individual
Prefix:MRS
First Name:PARVA
Middle Name:
Last Name:NOURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PARVA
Other - Middle Name:
Other - Last Name:NOURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1664 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5201
Mailing Address - Country:US
Mailing Address - Phone:619-579-8685
Mailing Address - Fax:
Practice Address - Street 1:317 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-458-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X, 390200000X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program