Provider Demographics
NPI:1770881781
Name:ALAMDARI, IZZAT (NP)
Entity type:Individual
Prefix:
First Name:IZZAT
Middle Name:
Last Name:ALAMDARI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 LOMITA BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5105
Mailing Address - Country:US
Mailing Address - Phone:310-784-6954
Mailing Address - Fax:310-326-5679
Practice Address - Street 1:2841 LOMITA BLVD STE 135
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5105
Practice Address - Country:US
Practice Address - Phone:310-784-6954
Practice Address - Fax:310-326-5679
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7480363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner