| NPI | 1376065433 |
|---|---|
| Doing Business As | IDDAD |
| Entity Type | Organization |
| Authorized Contact | BANAFSHEH PEZESHK President 760-607-6463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 102L00000X Psychoanalyst | |
| 103T00000X Psychologist | |
| 251S00000X Community/Behavioral Health | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2022-07-21 |