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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SOHA HEIDARI GONZALEZ PSY.D. (CLINIC DIRECTOR)
(818) 971-9194
Entity
Organization

Contact information

Practice address
2880 COCHRAN ST # 1009, SIMI VALLEY, CA 93065-0700
(818) 971-9194
(855) 270-9495
Mailing address
2880 COCHRAN ST # 1009, SIMI VALLEY, CA 93065-0700
(818) 971-9194
(855) 270-9495

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
103TC0700X
Clinical Psychologist
Primary
103TC1900X
Counseling Psychologist
103TC2200X
Clinical Child & Adolescent Psychologist
103TF0000X
Family Psychologist
103TS0200X
School Psychologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1275799298
CLINICAL PSYCHOLOGIST
CA
Enumeration date
11/09/2018
Last updated
12/28/2021
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