Provider Demographics
NPI:1760024376
Name:EBRAHIMIFARD, NEGIN (RD, CDE, CNSC)
Entity Type:Individual
Prefix:
First Name:NEGIN
Middle Name:
Last Name:EBRAHIMIFARD
Suffix:
Gender:F
Credentials:RD, CDE, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13003 20TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4121
Mailing Address - Country:US
Mailing Address - Phone:480-254-1884
Mailing Address - Fax:
Practice Address - Street 1:13003 20TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4121
Practice Address - Country:US
Practice Address - Phone:520-256-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86043491133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered