Provider Demographics
NPI:1366299414
Name:NEKOUFAR, ASHKAN
Entity type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:
Last Name:NEKOUFAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 LARWIN AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-7457
Mailing Address - Country:US
Mailing Address - Phone:805-444-8664
Mailing Address - Fax:
Practice Address - Street 1:10250 LARWIN AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-7457
Practice Address - Country:US
Practice Address - Phone:805-444-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist