Healthcare Provider Details

I. General information

NPI: 1518691989
Provider Name (Legal Business Name): NAZANINE BEHNAMFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9864 BALDWIN PL
EL MONTE CA
91731-2202
US

IV. Provider business mailing address

1720 PASEO LAGUNA
SAN DIMAS CA
91773-3947
US

V. Phone/Fax

Practice location:
  • Phone: 626-433-1311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: