Provider Demographics
NPI:1649282278
Name:BOOSTANFAR, SIMON (MD)
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:
Last Name:BOOSTANFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 LA VENTA RD STE 209
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3767
Mailing Address - Country:US
Mailing Address - Phone:805-497-1649
Mailing Address - Fax:805-497-1069
Practice Address - Street 1:1250 LA VENTA RD STE 209
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3767
Practice Address - Country:US
Practice Address - Phone:805-497-1649
Practice Address - Fax:805-497-1069
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA0313842080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology