Provider Demographics
NPI:1558118877
Name:ESFANDARMAZ, NIMA
Entity type:Individual
Prefix:
First Name:NIMA
Middle Name:
Last Name:ESFANDARMAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 VARIEL AVE APT 735
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3874
Mailing Address - Country:US
Mailing Address - Phone:818-699-2699
Mailing Address - Fax:
Practice Address - Street 1:6041 VARIEL AVE APT 735
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3874
Practice Address - Country:US
Practice Address - Phone:818-699-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)