Provider Demographics
NPI:1912313115
Name:CANDICE DANESHVAR MD INC
Entity type:Organization
Organization Name:CANDICE DANESHVAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:SHIRIN
Authorized Official - Last Name:DANESHVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-9978
Mailing Address - Street 1:6310 SAN VICENTE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5458
Mailing Address - Country:US
Mailing Address - Phone:310-274-9978
Mailing Address - Fax:310-274-0595
Practice Address - Street 1:6310 SAN VICENTE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5458
Practice Address - Country:US
Practice Address - Phone:310-274-9978
Practice Address - Fax:310-274-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121462207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty