Provider Demographics
NPI:1083436133
Name:AFSHAR, LILY (FNP-C)
Entity type:Individual
Prefix:MS
First Name:LILY
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:BAKESHLOU AFSHAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1965 PORT CARDIFF PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5416
Mailing Address - Country:US
Mailing Address - Phone:949-867-0185
Mailing Address - Fax:
Practice Address - Street 1:1965 PORT CARDIFF PL
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5416
Practice Address - Country:US
Practice Address - Phone:949-867-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9521096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily