Healthcare Provider Details

I. General information

NPI: 1194959379
Provider Name (Legal Business Name): MAHNAZ BRENDA AHANGAR RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 06/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S BUNDY DR #208
LOS ANGELES CA
90049-5247
US

IV. Provider business mailing address

809 S BUNDY DR #208
LOS ANGELES CA
90049-5247
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-0179
  • Fax:
Mailing address:
  • Phone: 310-795-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: