Provider Demographics
NPI:1881720803
Name:BEHZADI, SIMINDOKHT HESHMAT (LAC)
Entity type:Individual
Prefix:
First Name:SIMINDOKHT
Middle Name:HESHMAT
Last Name:BEHZADI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19463 HATTON ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2312
Mailing Address - Country:US
Mailing Address - Phone:818-516-4942
Mailing Address - Fax:
Practice Address - Street 1:28047 DOROTHY DR
Practice Address - Street 2:209
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4925
Practice Address - Country:US
Practice Address - Phone:818-516-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7650171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist