Provider Demographics
NPI:1205185840
Name:MOGHADAM, AFSAR
Entity Type:Individual
Prefix:
First Name:AFSAR
Middle Name:
Last Name:MOGHADAM
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 1:330 N FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2109
Mailing Address - Country:US
Mailing Address - Phone:818-432-5025
Mailing Address - Fax:818-766-3926
Practice Address - Street 1:12821 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3012
Practice Address - Country:US
Practice Address - Phone:818-432-5025
Practice Address - Fax:818-766-3926
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner