Provider Demographics
NPI:1457720666
Name:BARZEGAR, KATHLEEN LYONS (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LYONS
Last Name:BARZEGAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MOORPARK AVE
Mailing Address - Street 2:SC-109
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2723
Mailing Address - Country:US
Mailing Address - Phone:408-288-3724
Mailing Address - Fax:
Practice Address - Street 1:2100 MOORPARK AVE
Practice Address - Street 2:SC-109
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2723
Practice Address - Country:US
Practice Address - Phone:408-288-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 469455163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health