Provider Demographics
NPI:1861789729
Name:TEHRANI-VAFA, HOUMAN (PHARMD)
Entity type:Individual
Prefix:
First Name:HOUMAN
Middle Name:
Last Name:TEHRANI-VAFA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9049 ALCOTT ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3490
Mailing Address - Country:US
Mailing Address - Phone:310-652-3917
Mailing Address - Fax:
Practice Address - Street 1:13463 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5658
Practice Address - Country:US
Practice Address - Phone:310-754-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist