Provider Demographics
NPI:1831375302
Name:ACHACKZAD, NADER (MD)
Entity type:Individual
Prefix:
First Name:NADER
Middle Name:
Last Name:ACHACKZAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 MARTIN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2501
Mailing Address - Country:US
Mailing Address - Phone:408-988-8581
Mailing Address - Fax:408-988-8734
Practice Address - Street 1:1871 MARTIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2501
Practice Address - Country:US
Practice Address - Phone:408-988-8581
Practice Address - Fax:408-988-8734
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98178208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine