Provider Demographics
NPI:1164780086
Name:MEHRABIAN, DESIREE (RN, CDE)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:MEHRABIAN
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 MOORPARK AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2654
Mailing Address - Country:US
Mailing Address - Phone:408-998-2325
Mailing Address - Fax:408-998-2022
Practice Address - Street 1:2211 MOORPARK AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2654
Practice Address - Country:US
Practice Address - Phone:408-998-2325
Practice Address - Fax:408-998-2022
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN488865163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator