Healthcare Provider Details

I. General information

NPI: 1023874112
Provider Name (Legal Business Name): MYRDHAP IN-HOME DENTAL HYGIENE PRACTICE OF MAHNAZ TAYARANI RDHAP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SHELTER BAY AVE
MILL VALLEY CA
94941-3020
US

IV. Provider business mailing address

PO BOX 3
MILL VALLEY CA
94942-0003
US

V. Phone/Fax

Practice location:
  • Phone: 415-686-9394
  • Fax:
Mailing address:
  • Phone: 415-686-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MAHNAZ TAYARANI BABAI
Title or Position: PRESIDENT
Credential: RDHAP
Phone: 415-686-9394