Provider Demographics
NPI:1396578977
Name:ESMAEILIAN DEHAGHANI, SANAZ
Entity type:Individual
Prefix:MS
First Name:SANAZ
Middle Name:
Last Name:ESMAEILIAN DEHAGHANI
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 1:24951 CIRCLE DR STE 1605
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1718
Mailing Address - Country:US
Mailing Address - Phone:909-559-4599
Mailing Address - Fax:
Practice Address - Street 1:24951 CIRCLE DR STE 1605
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1718
Practice Address - Country:US
Practice Address - Phone:949-247-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant