Provider Demographics
NPI:1689186454
Name:MORADKHANI, ANIA
Entity Type:Individual
Prefix:
First Name:ANIA
Middle Name:
Last Name:MORADKHANI
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 1:2811 WILSHIRE BLVD STE 414
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4804
Mailing Address - Country:US
Mailing Address - Phone:310-552-9999
Mailing Address - Fax:310-201-6685
Practice Address - Street 1:2811 WILSHIRE BLVD STE 414
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4804
Practice Address - Country:US
Practice Address - Phone:310-552-9999
Practice Address - Fax:310-201-6685
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007903363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner