Active NPI
Pardis Khosravi, PSYD
- Clinical Psychologist
- San Carlos, CA
National Provider Identifier
1679821383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 31264
- Practice address
- 1303 San Carlos Ave
San Carlos, CA 94070-2317 - Phone
- (650) 394-5155
- NPI assigned
- Aug 28, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 31264 | CA | Primary |
Addresses
Primary practice location
1303 San Carlos Ave
San Carlos, CA 94070-2317
Mailing address
1303 San Carlos Ave
San Carlos, CA 94070-2317
Phone (650) 394-5155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31264 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787011200000",
"number": "1679821383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1303 SAN CARLOS AVE",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "940702317",
"telephone_number": "650-394-5155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1303 SAN CARLOS AVE",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "940702317",
"telephone_number": "650-394-5155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOSRAVI",
"first_name": "PARDIS",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-28",
"last_updated": "2026-08-18",
"certification_date": "2026-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "31264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Carlos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.