Provider Demographics
NPI:1912618844
Name:KAZEMI DALIRI, ROKSANA
Entity Type:Individual
Prefix:
First Name:ROKSANA
Middle Name:
Last Name:KAZEMI DALIRI
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 1:4103 VICTROLA DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2046
Mailing Address - Country:US
Mailing Address - Phone:408-499-3447
Mailing Address - Fax:
Practice Address - Street 1:1029 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-2415
Practice Address - Country:US
Practice Address - Phone:408-629-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist