Healthcare Provider Details

I. General information

NPI: 1922914423
Provider Name (Legal Business Name): ANDISHE FARAHMAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 TAMPA AVE
RESEDA CA
91335-3700
US

IV. Provider business mailing address

11510 MANCHESTER WAY
PORTER RANCH CA
91326-2459
US

V. Phone/Fax

Practice location:
  • Phone: 818-970-1488
  • Fax:
Mailing address:
  • Phone: 818-970-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86104408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: