Provider Demographics
NPI:1780229674
Name:FARAHBAKHSH, ANALIZA (FNP)
Entity Type:Individual
Prefix:
First Name:ANALIZA
Middle Name:
Last Name:FARAHBAKHSH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 INDEPENDENCE AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2984
Mailing Address - Country:US
Mailing Address - Phone:818-933-1920
Mailing Address - Fax:
Practice Address - Street 1:6530 INDEPENDENCE AVE APT 208
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2984
Practice Address - Country:US
Practice Address - Phone:818-933-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF11190032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily