Provider Demographics
NPI:1265799522
Name:FORAT, SHAHRZAD (DC, FNP)
Entity type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:FORAT
Suffix:
Gender:F
Credentials:DC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 VAN NUYS BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4834
Mailing Address - Country:US
Mailing Address - Phone:818-925-9692
Mailing Address - Fax:888-932-2444
Practice Address - Street 1:8215 VAN NUYS BLVD STE 212
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4834
Practice Address - Country:US
Practice Address - Phone:818-925-9692
Practice Address - Fax:888-932-2444
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21323111N00000X
CA95016470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor