Healthcare Provider Details

I. General information

NPI: 1881328243
Provider Name (Legal Business Name): MEHRDAD JAFARIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30837 E THOUSAND OAKS BLVD
WESTLAKE VILLAGE CA
91362-4039
US

IV. Provider business mailing address

6509 PLATT AVE
WEST HILLS CA
91307-3219
US

V. Phone/Fax

Practice location:
  • Phone: 818-879-2091
  • Fax:
Mailing address:
  • Phone: 310-598-0476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number48171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: