Provider Demographics
NPI:1184185225
Name:EGHTERAFI, NAVID DANIEL
Entity Type:Individual
Prefix:
First Name:NAVID
Middle Name:DANIEL
Last Name:EGHTERAFI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 VENTURA BLVD STE 509
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4824
Mailing Address - Country:US
Mailing Address - Phone:310-904-9698
Mailing Address - Fax:
Practice Address - Street 1:16661 VENTURA BLVD STE 509
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4824
Practice Address - Country:US
Practice Address - Phone:310-904-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAX6H9Y7W6247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other