Healthcare Provider Details

I. General information

NPI: 1356008866
Provider Name (Legal Business Name): SARA FARAZDAGHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 VAN NUYS BLVD
VAN NUYS CA
91405-1998
US

IV. Provider business mailing address

518 N SCHOOL ST
SANTA MARIA CA
93454-4138
US

V. Phone/Fax

Practice location:
  • Phone: 310-857-8497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: