Provider Demographics
NPI:1245713163
Name:THANO, SAIMIR (PHD)
Entity type:Individual
Prefix:DR
First Name:SAIMIR
Middle Name:
Last Name:THANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15560 TUSTIN VILLAGE WAY APT 26
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4264
Mailing Address - Country:US
Mailing Address - Phone:619-952-3952
Mailing Address - Fax:
Practice Address - Street 1:203 STUDENT SERVICES I
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-0001
Practice Address - Country:US
Practice Address - Phone:949-824-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical