Healthcare Provider Details

I. General information

NPI: 1124062401
Provider Name (Legal Business Name): ELHAM NEMAT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 VENTURA BLVD SUITE # 343
ENCINO CA
91436-2500
US

IV. Provider business mailing address

16101 VENTURA BLVD STE 343
ENCINO CA
91436-2516
US

V. Phone/Fax

Practice location:
  • Phone: 818-779-1447
  • Fax: 818-827-4748
Mailing address:
  • Phone: 818-779-1447
  • Fax: 818-827-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number27494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: