Provider Demographics
NPI:1891667424
Name:GOLESTANI HOTKNY, BAHAREH
Entity type:Individual
Prefix:MS
First Name:BAHAREH
Middle Name:
Last Name:GOLESTANI HOTKNY
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:ADNANE
Other - Middle Name:
Other - Last Name:EL FAHFOUHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21226 TRUMPET DR UNIT 205
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-4442
Mailing Address - Country:US
Mailing Address - Phone:818-572-3934
Mailing Address - Fax:
Practice Address - Street 1:21226 TRUMPET DR UNIT 205
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-4442
Practice Address - Country:US
Practice Address - Phone:818-572-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE8K9Y8K8246RP1900X
CA280996164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy