Provider Demographics
NPI:1518556430
Name:DANESHVAR, NOGOL (DC)
Entity Type:Individual
Prefix:
First Name:NOGOL
Middle Name:
Last Name:DANESHVAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 CALERO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4211
Mailing Address - Country:US
Mailing Address - Phone:916-952-4993
Mailing Address - Fax:
Practice Address - Street 1:17485 MONTEREY RD STE 307
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-3676
Practice Address - Country:US
Practice Address - Phone:916-952-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34854111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner