Healthcare Provider Details

I. General information

NPI: 1508667031
Provider Name (Legal Business Name): ELHAM KOWSAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20400 LONGBAY DR
YORBA LINDA CA
92887-3248
US

IV. Provider business mailing address

20400 LONGBAY DR
YORBA LINDA CA
92887-3248
US

V. Phone/Fax

Practice location:
  • Phone: 714-356-4991
  • Fax:
Mailing address:
  • Phone: 714-356-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: