Provider Demographics
NPI:1497319727
Name:EIZADI, LEAH NISSIM (RNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:NISSIM
Last Name:EIZADI
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:RACHEL
Other - Last Name:NISSIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 MOSELEY RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-7164
Mailing Address - Country:US
Mailing Address - Phone:650-223-4655
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily