Healthcare Provider Details

I. General information

NPI: 1043759772
Provider Name (Legal Business Name): SHYLAN MOZAFARI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 1806
LOS ANGELES CA
90067-2021
US

IV. Provider business mailing address

755 1/2 N HAYWORTH AVE
LOS ANGELES CA
90046-7144
US

V. Phone/Fax

Practice location:
  • Phone: 310-551-1711
  • Fax:
Mailing address:
  • Phone: 832-382-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019262
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95110982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: