Provider Demographics
NPI:1457176679
Name:NEKONEJAD, GOLNAZ NAZIE
Entity type:Individual
Prefix:
First Name:GOLNAZ
Middle Name:NAZIE
Last Name:NEKONEJAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26016 ALIZIA CANYON DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3428
Mailing Address - Country:US
Mailing Address - Phone:310-494-1094
Mailing Address - Fax:
Practice Address - Street 1:26565 AGOURA RD STE 200
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1990
Practice Address - Country:US
Practice Address - Phone:310-494-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist