Provider Demographics
NPI:1043857824
Name:ABDOLLAHI, MAHDIEH
Entity Type:Individual
Prefix:
First Name:MAHDIEH
Middle Name:
Last Name:ABDOLLAHI
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 1:1321 CALLE DE ORO
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7002
Mailing Address - Country:US
Mailing Address - Phone:818-521-9649
Mailing Address - Fax:
Practice Address - Street 1:12401 RIVERSIDE DR APT 4
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3523
Practice Address - Country:US
Practice Address - Phone:818-521-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18738171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist