Provider Demographics
NPI:1548520471
Name:SAN DIEGO PSYCHOLOGICAL & EDUCATIONAL SERVICES INC
Entity type:Organization
Organization Name:SAN DIEGO PSYCHOLOGICAL & EDUCATIONAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKHSHAB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-519-2510
Mailing Address - Street 1:13525 MIDLAND RD STE J
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4772
Mailing Address - Country:US
Mailing Address - Phone:760-519-2510
Mailing Address - Fax:760-230-1450
Practice Address - Street 1:13525 MIDLAND RD
Practice Address - Street 2:SUITE J
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4771
Practice Address - Country:US
Practice Address - Phone:760-789-7173
Practice Address - Fax:760-230-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS74895Medicare UPIN