Provider Demographics
NPI:1346677572
Name:AHMADI, NASRIN (DC)
Entity Type:Individual
Prefix:DR
First Name:NASRIN
Middle Name:
Last Name:AHMADI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NASRIN
Other - Middle Name:
Other - Last Name:AHMADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:9839 BELMAR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1655
Mailing Address - Country:US
Mailing Address - Phone:630-935-7306
Mailing Address - Fax:
Practice Address - Street 1:630 SHATTO PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1303
Practice Address - Country:US
Practice Address - Phone:323-810-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA51815363A00000X
CADC23479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor