Provider Demographics
NPI:1841550597
Name:DANESHVAR, CANDICE SHIRIN (MDD)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:SHIRIN
Last Name:DANESHVAR
Suffix:
Gender:F
Credentials:MDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 SAN VICENTE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5458
Mailing Address - Country:US
Mailing Address - Phone:310-274-9978
Mailing Address - Fax:310-274-0595
Practice Address - Street 1:6310 SAN VICENTE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5458
Practice Address - Country:US
Practice Address - Phone:310-274-9978
Practice Address - Fax:310-274-0595
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 121462207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology