Provider Demographics
NPI:1265163398
Name:FIROOZNIA, FARZANEH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:FARZANEH
Middle Name:
Last Name:FIROOZNIA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BETTONI AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8350
Mailing Address - Country:US
Mailing Address - Phone:949-526-2551
Mailing Address - Fax:
Practice Address - Street 1:AME MEDICAL GROUP, INC
Practice Address - Street 2:11938 PARAMOUNT BLVD.
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242
Practice Address - Country:US
Practice Address - Phone:949-526-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily