MEDICARE: FARIBA HAJY ISEYEDSOLEIMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95010091	CA

General Provider Information

NPI Number	:	1366911786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARIBA HAJY ISEYEDSOLEIMAN

Provider Business Mailing Address
First Line	:	125 HEATHER LN
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-3002
Country	:	US
Telephone Number	:	734-788-7815
Fax Number	:

Provider Business Practice Location Address
First Line	:	4067 TRANSPORT ST
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4914
Country	:	US
Telephone Number	:	650-384-0986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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