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General NPI Number Information
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NPI Number | 1417294265
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Entity Type | Individual
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Provider Name | TALAR FASSIH PA
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Gender | Female
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 20905 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91303-1743
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Country | US
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Telephone | 818-564-4961
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 179
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City | WOODLAND HILLS
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State | CA
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Zip | 91365-0179
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Country | US
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Telephone | 818-631-7399
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA22788
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License Number State | CA
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