Provider Demographics
NPI:1679896617
Name:AFROOZ, MITRA
Entity type:Individual
Prefix:MRS
First Name:MITRA
Middle Name:
Last Name:AFROOZ
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 1:23825 CROSSON DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4072
Mailing Address - Country:US
Mailing Address - Phone:818-535-7806
Mailing Address - Fax:818-888-0299
Practice Address - Street 1:18065 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3517
Practice Address - Country:US
Practice Address - Phone:818-535-7806
Practice Address - Fax:818-888-0299
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies