Provider Demographics
NPI:1356167274
Name:AMJADI, MAHYAR
Entity type:Individual
Prefix:
First Name:MAHYAR
Middle Name:
Last Name:AMJADI
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 1:1895 BOUNDARY PEAK ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5923
Mailing Address - Country:US
Mailing Address - Phone:818-430-2539
Mailing Address - Fax:
Practice Address - Street 1:1895 BOUNDARY PEAK ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5923
Practice Address - Country:US
Practice Address - Phone:818-430-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant