1215126701 NPI number — MISS MARYAM NAZIR RDHAP

Table of content: MISS MARYAM NAZIR RDHAP (NPI 1215126701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215126701 NPI number — MISS MARYAM NAZIR RDHAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAZIR
Provider First Name:
MARYAM
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RDHAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HESARI
Provider Other First Name:
MARYAM
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDHAP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215126701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10753 MOUNTAINER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUJUNGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-622-2894
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10753 MOUNTAINER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUJUNGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-622-2894
Provider Business Practice Location Address Fax Number:
916-622-2894
Provider Enumeration Date:
10/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  90 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y00090-01 . This is a "MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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