Healthcare Provider Details

I. General information

NPI: 1992025126
Provider Name (Legal Business Name): NARGES SHAHSAVARANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 NATIONAL BOULEVARD
LA CA
90034
US

IV. Provider business mailing address

9834 NATIONAL BOULEVARD
LA CA
90034
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-0623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH57932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: