Provider Demographics
NPI:1215372909
Name:THALJI, NADIA KHALIL (MA AND PHD STUDENT)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:KHALIL
Last Name:THALJI
Suffix:
Gender:F
Credentials:MA AND PHD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 N CLAREMONT ST
Mailing Address - Street 2:APT 5
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3270
Mailing Address - Country:US
Mailing Address - Phone:510-379-8114
Mailing Address - Fax:
Practice Address - Street 1:1330 LINCOLN AVE
Practice Address - Street 2:201
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2120
Practice Address - Country:US
Practice Address - Phone:415-459-5999
Practice Address - Fax:415-459-5602
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program