Provider Demographics
NPI:1871326587
Name:ROSTAMI, FARANAK N/A (NP)
Entity type:Individual
Prefix:
First Name:FARANAK
Middle Name:N/A
Last Name:ROSTAMI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6219 1/2 NITA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1822
Mailing Address - Country:US
Mailing Address - Phone:818-404-4672
Mailing Address - Fax:
Practice Address - Street 1:6219 1/2 NITA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1822
Practice Address - Country:US
Practice Address - Phone:818-404-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily