1457490682 NPI number — MISS SIMONE NOUSHIN LUNDQUIST MFTI, MHRS

Table of content: MISS SIMONE NOUSHIN LUNDQUIST MFTI, MHRS (NPI 1457490682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457490682 NPI number — MISS SIMONE NOUSHIN LUNDQUIST MFTI, MHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNDQUIST
Provider First Name:
SIMONE
Provider Middle Name:
NOUSHIN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MFTI, MHRS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KHAYYAMI
Provider Other First Name:
NOUSHIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFTI, MHRS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457490682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 MOORPARK AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95128-2631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-975-2730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 MOORPARK AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-975-2730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007

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: 106H00000X , with the licence number:  54190 , 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)





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