Provider Demographics
NPI:1780661249
Name:NADERI, SIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMA
Middle Name:
Last Name:NADERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 T ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4730
Mailing Address - Country:US
Mailing Address - Phone:916-734-3606
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:#3100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-5731
Practice Address - Fax:916-734-6548
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA828082471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A828080Medicare PIN
CARES000Medicare UPIN