Provider Demographics
NPI:1770093668
Name:SHAHPASANDZADEH, MINA (PHARMD)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:SHAHPASANDZADEH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MINA
Other - Middle Name:
Other - Last Name:SIASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1930 S BEVERLY GLEN BLVD APT 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5158
Mailing Address - Country:US
Mailing Address - Phone:310-977-9882
Mailing Address - Fax:
Practice Address - Street 1:2170 CENTURY PARK E APT 1601
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2231
Practice Address - Country:US
Practice Address - Phone:310-977-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist