Provider Demographics
NPI:1609438647
Name:SARBAZ, MINA
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:SARBAZ
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 1:1310 BARRY AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3955
Mailing Address - Country:US
Mailing Address - Phone:703-819-2896
Mailing Address - Fax:
Practice Address - Street 1:12520 MAGNOLIA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2355
Practice Address - Country:US
Practice Address - Phone:818-452-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5935213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist