Provider Demographics
NPI:1780004176
Name:MEHRANFARD, NIMA
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:MEHRANFARD
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 1:4448 MEADOWVILLE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1929
Mailing Address - Country:US
Mailing Address - Phone:408-315-8270
Mailing Address - Fax:
Practice Address - Street 1:2480 MISSION ST STE 331
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2487
Practice Address - Country:US
Practice Address - Phone:415-282-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32420111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation