Provider Demographics
NPI:1922275783
Name:FADAKI, NILOOFAR (MD)
Entity Type:Individual
Prefix:
First Name:NILOOFAR
Middle Name:
Last Name:FADAKI
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 1:2340 CLAY STREET,
Mailing Address - Street 2:2ND FLOOR, MELANOMA CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1932
Mailing Address - Country:US
Mailing Address - Phone:415-600-3800
Mailing Address - Fax:415-600-3865
Practice Address - Street 1:2340 CLAY STREET,
Practice Address - Street 2:2ND FLOOR (MELANOMA CENTER)
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-600-3800
Practice Address - Fax:415-600-3865
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program