Provider Demographics
NPI:1205096161
Name:RAHIMZADEH, NAFISEH
Entity type:Individual
Prefix:
First Name:NAFISEH
Middle Name:
Last Name:RAHIMZADEH
Suffix:
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 1:350 SHARON PARK DR
Mailing Address - Street 2:#N311
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6849
Mailing Address - Country:US
Mailing Address - Phone:650-570-6094
Mailing Address - Fax:650-570-6460
Practice Address - Street 1:350 SHARON PARK DR
Practice Address - Street 2:#N311
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6849
Practice Address - Country:US
Practice Address - Phone:650-570-6094
Practice Address - Fax:650-570-6460
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist