Provider Demographics
NPI:1548076607
Name:BAKHHTIAR, FIROZAN
Entity type:Individual
Prefix:MRS
First Name:FIROZAN
Middle Name:
Last Name:BAKHHTIAR
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 1:15293 WATERWHEEL TER
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3832
Mailing Address - Country:US
Mailing Address - Phone:202-725-0616
Mailing Address - Fax:
Practice Address - Street 1:15293 WATERWHEEL TER
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3832
Practice Address - Country:US
Practice Address - Phone:202-725-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT6P5AQ6374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide