Provider Demographics
NPI:1780264069
Name:ALIZADEH, SAHEL
Entity type:Individual
Prefix:
First Name:SAHEL
Middle Name:
Last Name:ALIZADEH
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 1:1475 ISLAND AVE UNIT 902
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8084
Mailing Address - Country:US
Mailing Address - Phone:305-934-3413
Mailing Address - Fax:
Practice Address - Street 1:2230 OTAY LAKES RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1000
Practice Address - Country:US
Practice Address - Phone:619-565-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95206849163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse