Provider Demographics
NPI:1649256140
Name:SHARIATI VARNOSFADERANI, NARGES (MD)
Entity type:Individual
Prefix:DR
First Name:NARGES
Middle Name:
Last Name:SHARIATI VARNOSFADERANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 MIKKELSEN DR
Mailing Address - Street 2:APT #1
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2001
Mailing Address - Country:US
Mailing Address - Phone:530-886-8483
Mailing Address - Fax:
Practice Address - Street 1:3111 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2456
Practice Address - Country:US
Practice Address - Phone:530-885-5618
Practice Address - Fax:530-889-0636
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A914110Medicaid
CAI35004Medicare UPIN
CA00A914110Medicaid