Healthcare Provider Details

I. General information

NPI: 1811300478
Provider Name (Legal Business Name): MEHRVASH DARABI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 1135
LOS ANGELES CA
90048-5917
US

IV. Provider business mailing address

3252 OVERLAND AVE APT 2
LOS ANGELES CA
90034-3543
US

V. Phone/Fax

Practice location:
  • Phone: 310-692-9659
  • Fax: 310-540-0733
Mailing address:
  • Phone: 805-405-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP950000324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: