Provider Demographics
NPI:1346064268
Name:ASGHARI, MADDIE (PMHNP)
Entity type:Individual
Prefix:
First Name:MADDIE
Middle Name:
Last Name:ASGHARI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-721-6295
Mailing Address - Fax:
Practice Address - Street 1:9663 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4303
Practice Address - Country:US
Practice Address - Phone:310-721-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032866363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health