Provider Demographics
NPI:1851525760
Name:ATAIE, DIBA II
Entity Type:Individual
Prefix:
First Name:DIBA
Middle Name:
Last Name:ATAIE
Suffix:II
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 1:42 LELAND DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2905
Mailing Address - Country:US
Mailing Address - Phone:415-897-5489
Mailing Address - Fax:
Practice Address - Street 1:42 LELAND DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-2905
Practice Address - Country:US
Practice Address - Phone:415-897-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program