Provider Demographics
NPI:1427410026
Name:HAYKANI, MASTANEH (PA)
Entity Type:Individual
Prefix:
First Name:MASTANEH
Middle Name:
Last Name:HAYKANI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 WARNALL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5339
Mailing Address - Country:US
Mailing Address - Phone:310-651-0970
Mailing Address - Fax:
Practice Address - Street 1:1744 WARNALL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5339
Practice Address - Country:US
Practice Address - Phone:310-651-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant