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General NPI Number Information
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NPI Number | 1386701498
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Entity Type | Individual
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Provider Name | ANA SHAHNEMATOLLAHI PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14624 SHERMAN WAY SUITE 603
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City | VAN NUYS
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State | CA
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Zip | 91405-2241
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Country | US
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Telephone | 818-994-0616
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Fax |
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Provider Business Mailing Address
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Address Line | 17350 W SUNSET BLVD. UNIT 101C
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-4103
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Country | US
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Telephone | 310-266-1343
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 17334
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License Number State | CA
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