Provider Demographics
NPI:1992961536
Name:SAFVATI, LADAN H
Entity type:Individual
Prefix:MS
First Name:LADAN
Middle Name:H
Last Name:SAFVATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 JONESBORO DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3626
Mailing Address - Country:US
Mailing Address - Phone:310-383-5654
Mailing Address - Fax:818-670-8832
Practice Address - Street 1:18345 VENTURA BLVD STE 507
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4245
Practice Address - Country:US
Practice Address - Phone:310-383-5654
Practice Address - Fax:818-760-8832
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51144106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist