Healthcare Provider Details

I. General information

NPI: 1235902255
Provider Name (Legal Business Name): FARISHTA NAHEBZADA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TENAYA DR
MODESTO CA
95354-3930
US

IV. Provider business mailing address

2801 GREWAL PKWY APT 821
MODESTO CA
95356-8024
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax:
Mailing address:
  • Phone: 463-201-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number63595
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number63595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: