Provider Demographics
NPI:1245497338
Name:SAMIA, DARUSH BEHZAD (RNFA)
Entity type:Individual
Prefix:MR
First Name:DARUSH
Middle Name:BEHZAD
Last Name:SAMIA
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:MR
Other - First Name:DARI
Other - Middle Name:BEHZAD
Other - Last Name:SAMIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNFA
Mailing Address - Street 1:39 VIA ADRIAN
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7026
Mailing Address - Country:US
Mailing Address - Phone:949-492-3646
Mailing Address - Fax:
Practice Address - Street 1:39 VIA ADRIAN
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-7026
Practice Address - Country:US
Practice Address - Phone:949-492-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-17
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN489520163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant