Provider Demographics
NPI:1982371035
Name:ATIGHETCHI, SARVENAZ
Entity Type:Individual
Prefix:
First Name:SARVENAZ
Middle Name:
Last Name:ATIGHETCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 ALCAZAR ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1003
Mailing Address - Country:US
Mailing Address - Phone:818-744-2890
Mailing Address - Fax:
Practice Address - Street 1:19812 MARIPOSA PINES WAY
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4138
Practice Address - Country:US
Practice Address - Phone:818-744-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48100390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program