Provider Demographics
NPI:1477259521
Name:GOSTARYFARD, ROSHANAK
Entity Type:Individual
Prefix:
First Name:ROSHANAK
Middle Name:
Last Name:GOSTARYFARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21021 ERWIN ST APT 440
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3845
Mailing Address - Country:US
Mailing Address - Phone:818-445-0546
Mailing Address - Fax:
Practice Address - Street 1:21021 ERWIN ST APT 440
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3845
Practice Address - Country:US
Practice Address - Phone:818-445-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-63763103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst