Provider Demographics
NPI:1477684249
Name:DARDASHTI, ROYA ELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROYA
Middle Name:ELIA
Last Name:DARDASHTI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:16250 VENTURA BLVD
Mailing Address - Street 2:345
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2204
Mailing Address - Country:US
Mailing Address - Phone:818-528-2559
Mailing Address - Fax:818-528-2588
Practice Address - Street 1:16250 VENTURA BLVD
Practice Address - Street 2:345
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2204
Practice Address - Country:US
Practice Address - Phone:818-528-2559
Practice Address - Fax:818-528-2588
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-10-25
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Provider Licenses
StateLicense IDTaxonomies
CAG083432208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43488Medicare UPIN