Provider Demographics
NPI:1588828081
Name:BEHZADIZADEH, ANAHID J (RNP)
Entity Type:Individual
Prefix:MS
First Name:ANAHID
Middle Name:J
Last Name:BEHZADIZADEH
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 WILSON TER
Mailing Address - Street 2:4TH FLOOR 4W ORTHPEDIC DEPARTMENT
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4007
Mailing Address - Country:US
Mailing Address - Phone:818-409-8000
Mailing Address - Fax:818-956-7640
Practice Address - Street 1:1509 WILSON TER
Practice Address - Street 2:4TH FLOOR 4W ORTHPEDIC DEPARTMENT
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:818-409-8000
Practice Address - Fax:818-956-7640
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505870163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP19838Medicaid
CAP19838Medicaid