Provider Demographics
NPI:1972880235
Name:BARKHORDARI, NOOSHIN YAZDI
Entity Type:Individual
Prefix:
First Name:NOOSHIN
Middle Name:YAZDI
Last Name:BARKHORDARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 WOODMAN AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2992
Mailing Address - Country:US
Mailing Address - Phone:818-207-2305
Mailing Address - Fax:
Practice Address - Street 1:9750 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6422
Practice Address - Country:US
Practice Address - Phone:818-899-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist