Healthcare Provider Details

I. General information

NPI: 1912436569
Provider Name (Legal Business Name): SHIRIN VALAFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 AVALON BLVD
LOS ANGELES CA
90011-5622
US

IV. Provider business mailing address

4211 S AVALON BLVD
LOS ANGELES CA
90011
US

V. Phone/Fax

Practice location:
  • Phone: 323-432-5183
  • Fax:
Mailing address:
  • Phone: 323-233-1532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: