Provider Demographics
NPI:1417171885
Name:HARIRIFAR, MOJGAN (NP)
Entity Type:Individual
Prefix:MS
First Name:MOJGAN
Middle Name:
Last Name:HARIRIFAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 MAGDALENA CR
Mailing Address - Street 2:# 39
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051
Mailing Address - Country:US
Mailing Address - Phone:408-296-3934
Mailing Address - Fax:
Practice Address - Street 1:750 WELCH RD
Practice Address - Street 2:# 200
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-723-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA012585Medicare UPIN