Provider Demographics
NPI:1962204685
Name:MAZRA, ARCHANA FAROUQUE (NP)
Entity type:Individual
Prefix:MRS
First Name:ARCHANA
Middle Name:FAROUQUE
Last Name:MAZRA
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16550 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1843
Mailing Address - Country:US
Mailing Address - Phone:818-256-6019
Mailing Address - Fax:
Practice Address - Street 1:5411 ETIWANDA AVE STE 100
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6159
Practice Address - Country:US
Practice Address - Phone:818-757-8839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034482363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology