Healthcare Provider Details

I. General information

NPI: 1245005339
Provider Name (Legal Business Name): POYA MOUSSAVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14724 VENTURA BLVD UNIT 1105
SHERMAN OAKS CA
91403-3501
US

IV. Provider business mailing address

14724 VENTURA BLVD UNIT 1105
SHERMAN OAKS CA
91403-3501
US

V. Phone/Fax

Practice location:
  • Phone: 818-836-0125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: