Provider Demographics
NPI:1093001331
Name:FARHADIAN, MAKHMAL (MAKHMAL FARHADIAN)
Entity Type:Individual
Prefix:
First Name:MAKHMAL
Middle Name:
Last Name:FARHADIAN
Suffix:
Gender:F
Credentials:MAKHMAL FARHADIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 S SHENANDOAH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3568
Mailing Address - Country:US
Mailing Address - Phone:310-666-1288
Mailing Address - Fax:
Practice Address - Street 1:1431 S SHENANDOAH ST APT 10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3568
Practice Address - Country:US
Practice Address - Phone:310-666-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program