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General NPI Number Information
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NPI Number | 1073235784
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Entity Type | Individual
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Provider Name | AVA BAZRAFSHAN
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 13803 FOOTHILL BLVD
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City | SYLMAR
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State | CA
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Zip | 91342-3013
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Country | US
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Telephone | 818-362-2816
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 SAN RAFAEL AVE APT 15
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City | GLENDALE
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State | CA
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Zip | 91202-3406
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 86805
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License Number State | CA
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