Provider Demographics
NPI:1174575245
Name:DAVOUDI, MARJAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:
Last Name:DAVOUDI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2585
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-2585
Mailing Address - Country:US
Mailing Address - Phone:858-205-5486
Mailing Address - Fax:
Practice Address - Street 1:3111 CAMINO DEL RIO N STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5724
Practice Address - Country:US
Practice Address - Phone:858-205-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006979103T00000X
CA23317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist