Provider Demographics
NPI:1821397761
Name:LIDA ESBATI MASHAYEKHI
Entity Type:Organization
Organization Name:LIDA ESBATI MASHAYEKHI
Other - Org Name:AANDLHHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:ESBATI
Authorized Official - Last Name:MASHAYEKHI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-474-1554
Mailing Address - Street 1:2597 BASIL LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077
Mailing Address - Country:US
Mailing Address - Phone:310-474-1554
Mailing Address - Fax:
Practice Address - Street 1:2597 BASIL LN
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-2003
Practice Address - Country:US
Practice Address - Phone:310-474-1554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520711251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care