Provider Demographics
NPI:1013553858
Name:JAMALI, ARYAN
Entity Type:Individual
Prefix:
First Name:ARYAN
Middle Name:
Last Name:JAMALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30423 CANWOOD ST STE 225
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4367
Mailing Address - Country:US
Mailing Address - Phone:818-871-9518
Mailing Address - Fax:818-871-9521
Practice Address - Street 1:30423 CANWOOD ST STE 225
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4367
Practice Address - Country:US
Practice Address - Phone:818-871-9518
Practice Address - Fax:818-871-9521
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012187363LF0000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily