Provider Demographics
NPI:1427296102
Name:FAGHIHI, JONAS KOUROSH (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JONAS
Middle Name:KOUROSH
Last Name:FAGHIHI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17944 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1029
Mailing Address - Country:US
Mailing Address - Phone:818-324-3636
Mailing Address - Fax:
Practice Address - Street 1:17944 COLLINS STREET
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-324-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist