Provider Demographics
NPI:1710674106
Name:RAJABI, MITRA (NP)
Entity Type:Individual
Prefix:
First Name:MITRA
Middle Name:
Last Name:RAJABI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MITRA
Other - Middle Name:
Other - Last Name:ENDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:171 DAWN RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 PALLADIO PKWY STE 1967
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8816
Practice Address - Country:US
Practice Address - Phone:925-300-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily