Healthcare Provider Details

I. General information

NPI: 1518556430
Provider Name (Legal Business Name): NOGOL DANESHVAR DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17485 MONTEREY RD STE 307
MORGAN HILL CA
95037-3676
US

IV. Provider business mailing address

482 CALERO AVE
SAN JOSE CA
95123-4211
US

V. Phone/Fax

Practice location:
  • Phone: 916-952-4993
  • Fax:
Mailing address:
  • Phone: 916-952-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number34854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: