Provider Demographics
NPI:1609639632
Name:MALEK MOHAMMADI, LIDA (RN)
Entity type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:
Last Name:MALEK MOHAMMADI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5277 ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1820
Mailing Address - Country:US
Mailing Address - Phone:818-836-1325
Mailing Address - Fax:
Practice Address - Street 1:5277 ELVIRA RD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1820
Practice Address - Country:US
Practice Address - Phone:818-836-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA793499163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse