Provider Demographics
NPI:1164721163
Name:DANIALIFAR, TANAZ FARZAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TANAZ
Middle Name:FARZAN
Last Name:DANIALIFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANAZ
Other - Middle Name:RIVKA
Other - Last Name:FARZAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10445 WILSHIRE BLVD APT 1502
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4664
Mailing Address - Country:US
Mailing Address - Phone:310-850-6484
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115306208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics