Provider Demographics
NPI:1245774793
Name:AFROOKHTEH, MAHSA MONICA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MAHSA
Middle Name:MONICA
Last Name:AFROOKHTEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 AVENTO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1872
Mailing Address - Country:US
Mailing Address - Phone:949-637-8287
Mailing Address - Fax:
Practice Address - Street 1:26777 AGOURA RD STE 4
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-2967
Practice Address - Country:US
Practice Address - Phone:949-637-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant