Healthcare Provider Details

I. General information

NPI: 1548895824
Provider Name (Legal Business Name): MAHSA HATAMIFAR RDCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 08/27/2026
Certification Date: 03/05/2021
Deactivation Date: 03/05/2021
Reactivation Date: 08/27/2026

III. Provider practice location address

5810 VAN NUYS BLVD
VAN NUYS CA
91401-4218
US

IV. Provider business mailing address

POBOX 25796
LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-310-4933
  • Fax: 310-307-2997
Mailing address:
  • Phone: 310-310-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number213801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: