Provider Demographics
NPI:1952492571
Name:NEKOORAD-LONG, HALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:HALEH
Middle Name:
Last Name:NEKOORAD-LONG
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 1:3609 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1709
Mailing Address - Country:US
Mailing Address - Phone:415-237-0377
Mailing Address - Fax:415-484-1944
Practice Address - Street 1:3609 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1709
Practice Address - Country:US
Practice Address - Phone:415-237-0377
Practice Address - Fax:415-484-1944
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1744712084P0800X
CO414842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46661Medicare UPIN
CO497328Medicare ID - Type Unspecified