Individual
MRS. HOMA IZADYAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13716 SHERMAN WAY, VAN NUYS, CA 91405-2626
(818) 988-2020
Mailing address
PO BOX 371044, RESEDA, CA 91337-1044
(818) 517-3172
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA56101
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OA261
—
CA
05
—
RDA56101
—
CA
Enumeration date
11/11/2020
Last updated
11/11/2020
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