Healthcare Provider Details

I. General information

NPI: 1356658660
Provider Name (Legal Business Name): NILI KHADEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18011 ZELZAH AVE
GRANADA HILLS CA
91344
US

IV. Provider business mailing address

6410 PLATT AVE
WEST HILLS CA
91307-3216
US

V. Phone/Fax

Practice location:
  • Phone: 818-360-8411
  • Fax:
Mailing address:
  • Phone: 818-348-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: