Provider Demographics
NPI:1164385571
Name:FAKOUR, AFSANEH (RD)
Entity type:Individual
Prefix:
First Name:AFSANEH
Middle Name:
Last Name:FAKOUR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EDGAR CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4329
Mailing Address - Country:US
Mailing Address - Phone:805-824-3230
Mailing Address - Fax:805-824-3230
Practice Address - Street 1:16 EDGAR CT
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4329
Practice Address - Country:US
Practice Address - Phone:805-824-3230
Practice Address - Fax:805-824-3230
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86078853133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered