Provider Demographics
NPI:1750114112
Name:POURFARD, NAHAL
Entity type:Individual
Prefix:
First Name:NAHAL
Middle Name:
Last Name:POURFARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAHAL
Other - Middle Name:
Other - Last Name:PAK JESMPOUR FARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 SENDERO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3012
Mailing Address - Country:US
Mailing Address - Phone:949-292-5009
Mailing Address - Fax:
Practice Address - Street 1:33 SENDERO
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3012
Practice Address - Country:US
Practice Address - Phone:949-292-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program