Healthcare Provider Details

I. General information

NPI: 1043236458
Provider Name (Legal Business Name): HAYVENHURST INFECTIOUS DIS. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4054 STRAWBERRY PL
ENCINO CA
91436-3826
US

IV. Provider business mailing address

4054 STRAWBERRY PL
ENCINO CA
91436-3826
US

V. Phone/Fax

Practice location:
  • Phone: 310-914-9150
  • Fax: 310-914-9705
Mailing address:
  • Phone: 310-914-9150
  • Fax: 310-914-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA65901
License Number StateCA

VIII. Authorized Official

Name: DR. ALAN NAZARIAN
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 310-914-9150