Provider Demographics
NPI:1689287732
Name:KHALILI, GULAGHA
Entity Type:Individual
Prefix:
First Name:GULAGHA
Middle Name:
Last Name:KHALILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BOULDER CT STE 100C
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8313
Mailing Address - Country:US
Mailing Address - Phone:925-444-5900
Mailing Address - Fax:
Practice Address - Street 1:440 BOULDER CT STE 100C
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8313
Practice Address - Country:US
Practice Address - Phone:925-444-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)