Individual
AZAR S BASTANFAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERTIFIED NURSE PRAC
Contact information
Practice address
9850 GENESEE AVE, SUITE 600, LA JOLLA, CA 92037-1207
(858) 453-0753
(760) 414-3713
Mailing address
FILE #54433, LOS ANGELES, CA 90074-4433
(858) 784-5888
(760) 414-3713
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9526
CA
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
538431
CA
Other
Enumeration date
07/16/2006
Last updated
08/15/2011
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