Healthcare Provider Details

I. General information

NPI: 1386721629
Provider Name (Legal Business Name): MRS. SHIRIN B AFSHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 PLANT AVE B
REDONDO BEACH CA
90278-1950
US

IV. Provider business mailing address

1902 PLANT AVE B
REDONDO BEACH CA
90278-1950
US

V. Phone/Fax

Practice location:
  • Phone: 310-880-0730
  • Fax:
Mailing address:
  • Phone: 310-880-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: