Individual
ANDIA EZZATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5501 NEWCASTLE AVE APT 202, ENCINO, CA 91316-2176
(818) 277-9442
Mailing address
5501 NEWCASTLE AVE APT 202, ENCINO, CA 91316-2176
(818) 277-9442
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
109836
CA
Other
Enumeration date
02/21/2024
Last updated
01/08/2025
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