Provider Demographics
NPI:1558542753
Name:DEHDASHTI, ALMA LEYLA (DO)
Entity Type:Individual
Prefix:DR
First Name:ALMA
Middle Name:LEYLA
Last Name:DEHDASHTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11600 INDIAN HILLS RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1225
Mailing Address - Country:US
Mailing Address - Phone:818-838-4524
Mailing Address - Fax:818-838-7565
Practice Address - Street 1:11600 INDIAN HILLS RD STE 200A
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1225
Practice Address - Country:US
Practice Address - Phone:818-838-4524
Practice Address - Fax:818-838-7565
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020190207N00000X
MI5315058380207N00000X
CA20A13921207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB241305Medicare PIN