Healthcare Provider Details

I. General information

NPI: 1487534707
Provider Name (Legal Business Name): SALEENA KHOSHNEVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21015 PATHFINDER RD STE 100
DIAMOND BAR CA
91765-4002
US

IV. Provider business mailing address

21015 PATHFINDER RD STE 100
DIAMOND BAR CA
91765-4002
US

V. Phone/Fax

Practice location:
  • Phone: 909-861-3511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: