Individual
SAMANEH FANAEIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2656 29TH ST STE 202, SANTA MONICA, CA 90405-2984
(310) 503-0221
Mailing address
3931 W 58TH PL, LOS ANGELES, CA 90043-2913
(916) 335-0727
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95017465
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417621434
—
CA
Enumeration date
08/03/2021
Last updated
01/02/2023
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