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General NPI Number Information
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NPI Number | 1033098199
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Entity Type | Individual
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Provider Name | DERIK KHOSROVIAN DPT
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Gender | Male
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 425 LOMBARD ST
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5898
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Country | US
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Telephone | 805-494-4145
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Fax |
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Provider Business Mailing Address
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Address Line | 12601 CREWE ST
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-5307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT308745
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License Number State | CA
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