Healthcare Provider Details

I. General information

NPI: 1730338955
Provider Name (Legal Business Name): FARNAZ MIZRAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E COLORADO ST
GLENDALE CA
91205-1514
US

IV. Provider business mailing address

20525 VISTA DE ORO PL
WOODLAND HILLS CA
91364-3431
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-7257
  • Fax:
Mailing address:
  • Phone: 818-346-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: