Provider Demographics
NPI:1891979985
Name:NAMIRI KALANTARI, PARVANEH (CDE)
Entity Type:Individual
Prefix:MRS
First Name:PARVANEH
Middle Name:
Last Name:NAMIRI KALANTARI
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:MRS
Other - First Name:PARVANEH
Other - Middle Name:
Other - Last Name:KALANTARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:11165 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1113
Practice Address - Country:US
Practice Address - Phone:818-365-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713180133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMNT713180Medicare PIN
CAAU175ZMedicare PIN