Provider Demographics
NPI:1760673073
Name:KHALILIFARD, FARINAZ
Entity type:Individual
Prefix:MRS
First Name:FARINAZ
Middle Name:
Last Name:KHALILIFARD
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 1:12669 ENCINITAS AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3635
Mailing Address - Country:US
Mailing Address - Phone:818-838-7696
Mailing Address - Fax:
Practice Address - Street 1:12669 ENCINITAS AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3635
Practice Address - Country:US
Practice Address - Phone:818-838-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7484Medicaid