Provider Demographics
NPI:1669888574
Name:BASHARDOUST, NUSHA (PA-C)
Entity type:Individual
Prefix:
First Name:NUSHA
Middle Name:
Last Name:BASHARDOUST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23622 CALABASAS RD
Mailing Address - Street 2:#339
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1549
Mailing Address - Country:US
Mailing Address - Phone:818-225-0117
Mailing Address - Fax:818-225-0127
Practice Address - Street 1:23622 CALABASAS RD
Practice Address - Street 2:#339
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1549
Practice Address - Country:US
Practice Address - Phone:818-225-0117
Practice Address - Fax:818-225-0127
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA51713207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology