Provider Demographics
NPI:1376911479
Name:MIRZAKHANY, FLORA
Entity type:Individual
Prefix:
First Name:FLORA
Middle Name:
Last Name:MIRZAKHANY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FLORA
Other - Middle Name:M
Other - Last Name:PETROSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4021
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91041-4021
Mailing Address - Country:US
Mailing Address - Phone:818-521-2827
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 4021
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91041-4021
Practice Address - Country:US
Practice Address - Phone:818-521-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1233281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical