Healthcare Provider Details

I. General information

NPI: 1437755667
Provider Name (Legal Business Name): PIROOZ ESLAMI FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 VENTURA BLVD UNIT 2119
WOODLAND HILLS CA
91364-6671
US

IV. Provider business mailing address

20600 VENTURA BLVD UNIT 2119
WOODLAND HILLS CA
91364-6671
US

V. Phone/Fax

Practice location:
  • Phone: 310-890-8749
  • Fax:
Mailing address:
  • Phone: 310-890-8749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: