Provider Demographics
NPI:1700571072
Name:EGHBALI, SEYEDE TANNAZ
Entity Type:Individual
Prefix:
First Name:SEYEDE TANNAZ
Middle Name:
Last Name:EGHBALI
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:UHS SOCAL MEDICAL EDUCATION CONSORTIUM 31700
Mailing Address - Street 2:TEMECULA PARKWAY PARKWAY SUITES # 1- GME
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UHS SOCAL MEDICAL EDUCATION CONSORTIUM 31700
Practice Address - Street 2:TEMECULA PARKWAY PARKWAY SUITES # 1- GME
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-331-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program