Healthcare Provider Details

I. General information

NPI: 1306936687
Provider Name (Legal Business Name): MOJDEH ZAFARANCHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22110 ROSCOE BLVD 303
CANOGA PARK CA
91304-3845
US

IV. Provider business mailing address

22110 ROSCOE BLVD 303
CANOGA PARK CA
91304-3845
US

V. Phone/Fax

Practice location:
  • Phone: 818-887-5515
  • Fax: 818-887-5373
Mailing address:
  • Phone: 818-887-5515
  • Fax: 818-887-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA049235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: