Provider Demographics
NPI:1821573403
Name:BIDARI, ZAHRA (AGNP)
Entity Type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:BIDARI
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 S WESTLAKE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2921
Mailing Address - Country:US
Mailing Address - Phone:818-468-1319
Mailing Address - Fax:
Practice Address - Street 1:875 S WESTLAKE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2921
Practice Address - Country:US
Practice Address - Phone:805-497-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009603363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology