Provider Demographics
NPI:1306214622
Name:FERDOWSI, JAVAD
Entity Type:Individual
Prefix:
First Name:JAVAD
Middle Name:
Last Name:FERDOWSI
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 1:11916 GORHAM AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5320
Mailing Address - Country:US
Mailing Address - Phone:310-442-7771
Mailing Address - Fax:
Practice Address - Street 1:11916 GORHAM AVE APT 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5320
Practice Address - Country:US
Practice Address - Phone:310-442-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 37587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist