Provider Demographics
NPI:1841598232
Name:SIAVOSHI, NAHID (NP)
Entity Type:Individual
Prefix:MRS
First Name:NAHID
Middle Name:
Last Name:SIAVOSHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18706
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-8706
Mailing Address - Country:US
Mailing Address - Phone:714-262-8977
Mailing Address - Fax:951-735-5572
Practice Address - Street 1:2791 GREEN RIVER RD STE 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7452
Practice Address - Country:US
Practice Address - Phone:951-735-5570
Practice Address - Fax:951-735-5572
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily