Provider Demographics
NPI:1467287755
Name:SAFA, SOOSAN (CHHA)
Entity type:Individual
Prefix:MS
First Name:SOOSAN
Middle Name:
Last Name:SAFA
Suffix:
Gender:F
Credentials:CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 ZELZAH AVENUE, UNIT 201
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2231
Mailing Address - Country:US
Mailing Address - Phone:310-270-6005
Mailing Address - Fax:
Practice Address - Street 1:5417 ZELZAH AVE., # UNIT 201
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2231
Practice Address - Country:US
Practice Address - Phone:310-270-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide