Provider Demographics
NPI:1972481125
Name:DEZFULI, NICKI
Entity type:Individual
Prefix:
First Name:NICKI
Middle Name:
Last Name:DEZFULI
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 1:145 CHESTNUT ST APT 414
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3801
Mailing Address - Country:US
Mailing Address - Phone:760-835-9669
Mailing Address - Fax:
Practice Address - Street 1:5000 W SUNSET BLVD STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5863
Practice Address - Country:US
Practice Address - Phone:760-835-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program