Provider Demographics
NPI:1710690151
Name:ASHTIANI, ASAL NATALIE
Entity Type:Individual
Prefix:
First Name:ASAL
Middle Name:NATALIE
Last Name:ASHTIANI
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 1:208 S LASKY DR UNIT 301
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3652
Mailing Address - Country:US
Mailing Address - Phone:310-430-0564
Mailing Address - Fax:
Practice Address - Street 1:208 S LASKY DR UNIT 301
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3652
Practice Address - Country:US
Practice Address - Phone:310-430-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH87222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist