Provider Demographics
NPI:1114799608
Name:MAZLOUMI, BANAFSHEH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BANAFSHEH
Middle Name:
Last Name:MAZLOUMI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21166 W CANYON VIEW PL
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1369
Mailing Address - Country:US
Mailing Address - Phone:818-339-7416
Mailing Address - Fax:
Practice Address - Street 1:21166 W CANYON VIEW PL
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1369
Practice Address - Country:US
Practice Address - Phone:818-339-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily