Healthcare Provider Details

I. General information

NPI: 1982904256
Provider Name (Legal Business Name): KHOOSHEH DANESHI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 SANTA BARBARA ST
SANTA BARBARA CA
93105-3544
US

IV. Provider business mailing address

21559 MULHOLLAND DR
WOODLAND HILLS CA
91364-5345
US

V. Phone/Fax

Practice location:
  • Phone: 800-340-1099
  • Fax:
Mailing address:
  • Phone: 310-295-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: