Provider Demographics
NPI:1043746316
Name:BAHAREH FAZILAT MD INC
Entity Type:Organization
Organization Name:BAHAREH FAZILAT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BAHAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZILAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-525-8898
Mailing Address - Street 1:5924 LASAINE AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1352
Mailing Address - Country:US
Mailing Address - Phone:786-525-8898
Mailing Address - Fax:
Practice Address - Street 1:4940 VAN NUYS BLVD STE 302
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1743
Practice Address - Country:US
Practice Address - Phone:310-507-7748
Practice Address - Fax:310-598-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty