Healthcare Provider Details

I. General information

NPI: 1720236243
Provider Name (Legal Business Name): MS. NILOFAR MIRCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 JONES WAY STE 10
SIMI VALLEY CA
93065-1215
US

IV. Provider business mailing address

2650 JONES WAY STE 10
SIMI VALLEY CA
93065-1215
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-5345
  • Fax:
Mailing address:
  • Phone: 805-522-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: