Healthcare Provider Details

I. General information

NPI: 1023799293
Provider Name (Legal Business Name): MEHRNAZ AKHAVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E FLORENCE AVE STE B&C
LOS ANGELES CA
90001-1963
US

IV. Provider business mailing address

740 W ALLUVIAL AVE STE 101
FRESNO CA
93711-5509
US

V. Phone/Fax

Practice location:
  • Phone: 232-457-9278
  • Fax:
Mailing address:
  • Phone: 323-630-3250
  • Fax: 559-432-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: