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General NPI Number Information
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NPI Number | 1518159730
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Entity Type | Organization
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Legal Business Name | MEHRAN NOWFAR-RAD, M.D., INC.
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Dates
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Enumeration Date | 08/11/2007
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Last Update Date | 08/11/2007
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Provider Practice Location Address
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Address Line | 5400 BALBOA BLVD SUITE # 217
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City | ENCINO
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State | CA
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Zip | 91316-1502
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Country | US
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Telephone | 818-990-9665
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 BALBOA BLVD SUITE # 217
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City | ENCINO
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State | CA
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Zip | 91316-1502
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Country | US
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Telephone | 818-990-9665
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEHRAN NOWFAR-RAD
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Credential | M.D.
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Telephone | 818-990-9665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A66360
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License Number State | CA
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