Provider Demographics
NPI:1831453075
Name:AFSHARTAVANA, NAHAL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NAHAL
Middle Name:
Last Name:AFSHARTAVANA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19100 VENTURA BLVD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3239
Mailing Address - Country:US
Mailing Address - Phone:818-708-7704
Mailing Address - Fax:
Practice Address - Street 1:19100 VENTURA BLVD
Practice Address - Street 2:SUITE Q
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3239
Practice Address - Country:US
Practice Address - Phone:818-708-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist