Healthcare Provider Details

I. General information

NPI: 1982934071
Provider Name (Legal Business Name): MISS ROZA KALANTARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S DOHENY DR APT 1022
LOS ANGELES CA
90048-2997
US

IV. Provider business mailing address

100 S DOHENY DR APT 1022
LOS ANGELES CA
90048-2997
US

V. Phone/Fax

Practice location:
  • Phone: 310-592-9796
  • Fax:
Mailing address:
  • Phone: 310-592-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: