Provider Demographics
NPI:1760491013
Name:DADKHAH, SHOLEH
Entity Type:Individual
Prefix:
First Name:SHOLEH
Middle Name:
Last Name:DADKHAH
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 1:9293 ADOLPHIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3525
Mailing Address - Country:US
Mailing Address - Phone:858-484-3536
Mailing Address - Fax:
Practice Address - Street 1:7590 MIRAMAR RD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4232
Practice Address - Country:US
Practice Address - Phone:858-549-4298
Practice Address - Fax:858-536-9461
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist