Provider Demographics
NPI:1649590712
Name:QADERI, SARA
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:QADERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 CARDINAL DR APT 27
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4132
Mailing Address - Country:US
Mailing Address - Phone:858-278-0866
Mailing Address - Fax:
Practice Address - Street 1:2440 CARDINAL DR APT 27
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4132
Practice Address - Country:US
Practice Address - Phone:858-278-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist