Provider Demographics
NPI:1942718903
Name:SEIFPOUR, MASOOMEH
Entity type:Individual
Prefix:
First Name:MASOOMEH
Middle Name:
Last Name:SEIFPOUR
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 1:23986 ALISO CREEK RD # 761
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3908
Mailing Address - Country:US
Mailing Address - Phone:949-633-8255
Mailing Address - Fax:
Practice Address - Street 1:23986 ALISO CREEK RD # 761
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3908
Practice Address - Country:US
Practice Address - Phone:949-633-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-28732103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst