Provider Demographics
NPI:1861015588
Name:NAJAFI FASHTAMI, NEDA
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:NAJAFI FASHTAMI
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 1:1360 S ANAHEIM BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6205
Mailing Address - Country:US
Mailing Address - Phone:714-776-1231
Mailing Address - Fax:714-776-0802
Practice Address - Street 1:1360 S ANAHEIM BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6205
Practice Address - Country:US
Practice Address - Phone:714-776-1231
Practice Address - Fax:714-776-0802
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CASPA63292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst