Provider Demographics
NPI:1265994990
Name:GHAZI-MOGHADDAM, NOOSHIN (RD)
Entity type:Individual
Prefix:
First Name:NOOSHIN
Middle Name:
Last Name:GHAZI-MOGHADDAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COLERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2602
Mailing Address - Country:US
Mailing Address - Phone:407-462-0402
Mailing Address - Fax:
Practice Address - Street 1:125 COLERIDGE CT
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2602
Practice Address - Country:US
Practice Address - Phone:407-462-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered