Provider Demographics
NPI:1780208603
Name:JEIROODI, MARYAM (PA-C)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:JEIROODI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:
Other - Last Name:BORZABADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6600 COYLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6344
Mailing Address - Country:US
Mailing Address - Phone:916-245-2444
Mailing Address - Fax:
Practice Address - Street 1:6600 COYLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6344
Practice Address - Country:US
Practice Address - Phone:916-245-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant