Provider Demographics
NPI:1346002698
Name:ELYASIAN, FARNOOD
Entity Type:Individual
Prefix:
First Name:FARNOOD
Middle Name:
Last Name:ELYASIAN
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 1:5348 NEWCASTLE AVE APT 130
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3035
Mailing Address - Country:US
Mailing Address - Phone:818-939-3096
Mailing Address - Fax:
Practice Address - Street 1:5348 NEWCASTLE AVE APT 130
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3035
Practice Address - Country:US
Practice Address - Phone:818-939-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst