Healthcare Provider Details

I. General information

NPI: 1558840025
Provider Name (Legal Business Name): NEILUFAR JAVIDZAD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8665 WILSHIRE BLVD STE 402
BEVERLY HILLS CA
90211-2933
US

IV. Provider business mailing address

8665 WILSHIRE BLVD STE 412
BEVERLY HILLS CA
90211-2933
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-9511
  • Fax:
Mailing address:
  • Phone: 310-962-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: