Healthcare Provider Details

I. General information

NPI: 1205839966
Provider Name (Legal Business Name): FARNAZ DADMANESH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD RM 8725
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

31255 CEDAR VALLEY DR STE 324
WESTLAKE VILLAGE CA
91362-7129
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6627
  • Fax: 310-423-0170
Mailing address:
  • Phone: 818-338-8103
  • Fax: 818-338-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA72879
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA72879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: