Provider Demographics
NPI:1710145958
Name:CALLAHAN, FAHIMAH YAZDANFARD (RD)
Entity Type:Individual
Prefix:MRS
First Name:FAHIMAH
Middle Name:YAZDANFARD
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KNIGHTS PEAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2511
Mailing Address - Country:US
Mailing Address - Phone:210-872-6105
Mailing Address - Fax:
Practice Address - Street 1:14832 MAIN ST.
Practice Address - Street 2:USRENAL CARETRI-COUNTY DIALYSIS
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052
Practice Address - Country:US
Practice Address - Phone:830-772-5784
Practice Address - Fax:830-772-5793
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT 80799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered