Provider Demographics
NPI:1144214800
Name:NEJAD, MAHTAB Z (DC)
Entity Type:Individual
Prefix:MRS
First Name:MAHTAB
Middle Name:Z
Last Name:NEJAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:MAHTAB
Other - Middle Name:
Other - Last Name:ZARGARIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5471
Mailing Address - Country:US
Mailing Address - Phone:408-866-5120
Mailing Address - Fax:408-866-5005
Practice Address - Street 1:1848 SARATOGA AVE
Practice Address - Street 2:BLD #1 SUITE #2
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6612
Practice Address - Country:US
Practice Address - Phone:408-866-5120
Practice Address - Fax:408-866-5005
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88075Medicare UPIN
CADC2599531Medicare ID - Type Unspecified