Healthcare Provider Details

I. General information

NPI: 1639641699
Provider Name (Legal Business Name): ZAHRA JEYLANI NUR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15101 SPECTRUM
IRVINE CA
92618-3426
US

IV. Provider business mailing address

164 W HOSPITALITY LN STE 1A
SAN BERNARDINO CA
92408-3328
US

V. Phone/Fax

Practice location:
  • Phone: 619-319-0176
  • Fax:
Mailing address:
  • Phone: 909-723-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95010495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: