Provider Demographics
NPI:1184746646
Name:GHANDEHARI, CORAZON F (RN)
Entity type:Individual
Prefix:
First Name:CORAZON
Middle Name:F
Last Name:GHANDEHARI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COFFEE RD
Mailing Address - Street 2:C3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4241
Mailing Address - Country:US
Mailing Address - Phone:209-529-9603
Mailing Address - Fax:209-529-6610
Practice Address - Street 1:817 COFFEE RD
Practice Address - Street 2:C3
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4241
Practice Address - Country:US
Practice Address - Phone:209-529-9603
Practice Address - Fax:209-529-6610
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464795163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant