Provider Demographics
NPI:1457536518
Name:MOODY, PARIVASH (FNP)
Entity type:Individual
Prefix:MRS
First Name:PARIVASH
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:PARIVASH
Other - Middle Name:
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1642 E CAPITOL EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1800
Mailing Address - Country:US
Mailing Address - Phone:408-445-3431
Mailing Address - Fax:408-238-3874
Practice Address - Street 1:1642 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1800
Practice Address - Country:US
Practice Address - Phone:408-445-3431
Practice Address - Fax:408-238-3874
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 15361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily