Provider Demographics
NPI:1760679484
Name:GHAZANFAR, KHATERA (DO)
Entity Type:Individual
Prefix:DR
First Name:KHATERA
Middle Name:
Last Name:GHAZANFAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4663 CAHUENGA BLVD UNIT 202
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1659
Mailing Address - Country:US
Mailing Address - Phone:818-681-3711
Mailing Address - Fax:
Practice Address - Street 1:3303 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2803
Practice Address - Country:US
Practice Address - Phone:323-478-8200
Practice Address - Fax:323-221-2022
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A101332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry